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Zeppieri M.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Brusini P.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Parisi L.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Johnson C.A.,Devers Eye Institute | And 3 more authors.
American Journal of Ophthalmology | Year: 2010

Purpose: To assess the ability of Pulsar perimetry (Pulsar) in detecting early glaucomatous visual field (VF) damage in comparison with Frequency Doubling Technology (FDT), Scanning Laser Polarimetry (SLP, GDx VCC), and Heidelberg Retina Tomography (HRT). Design: Prospective observational cross-sectional case study. Methods: This multicenter study included: 87 ocular hypertensives (OHT); 67 glaucomatous optic neuropathy (GON) patients; 75 primary open-angle glaucoma (POAG) patients; and 90 normals. All patients underwent standard automated perimetry (SAP) HFA 30-2, Pulsar T30W, FDT N-30, HRT II, and GDx VCC. Area under Receiver Operating Characteristic Curves (AROCs) for discriminating between healthy and glaucomatous eyes and agreement among instruments were determined. Results: The best parameters for Pulsar, FDT, HRT, and GDx were, respectively: loss variance square root; no. of areas with P< 5%; Cup-Shape-Measure; and Nerve Fiber Indicator (NFI). In detecting POAG eyes, Pulsar (AROC, 0.90) appeared comparable with FDT (0.89) and significantly better than HRT (0.82) and GDx (0.79). For GON, Pulsar ability (0.74) was higher than GDx (0.69) and lower than FDT (0.80) and HRT (0.83). The agreement among instruments ranged from 0.12 to 0.56. Pulsar test duration was significantly shorter than SAP and FDT (P< .001). Conclusions: Pulsar T30W test is a rapid and easy perimetric method, showing higher sensitivity than SAP in detecting early glaucomatous VF loss. Its diagnostic ability is good for detecting early perimetric POAG eyes and fair for GON eyes. Pulsar performance was comparable with FDT, HRT, and GDx, even if the agreement between instruments was poor to fair. © 2010 Elsevier Inc. All rights reserved.


Tallandini M.A.,University of Trieste | Tallandini M.A.,University College London | Morsan V.,University of Trieste | Gronchi G.,University of Florence | Macagno F.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia
Journal of Pediatric Psychology | Year: 2014

Objective Parental perception of a child vulnerability (PPCV) to illness, not justified by medically noticeable symptoms, is a situation well known to medical and paramedical staff. It is still disputed whether PPCV is triggered by the child's health problems or by parental emotional status. This review is aimed to clarify the etiology of PPCV in instances of preterm birth. Method PRISMA guidelines were followed. MEDLINE and Scopus indexes were searched. Of the 70 articles yielded by the search, 14 met the inclusion criteria for the systematic review, of which 10 could be included in the meta-analysis. Results Children's physiological factors and parents' psychological factors were both found to significantly influence PPCV, in different ways, at different ages of the child. Conclusion PPCV etiology appears to mostly depend on parents' psychological factors. A better understanding of PPCV etiology could help protect children from distorted parental interaction and reduce parental demands for unnecessary medical care. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.


Raimondi F.,University of Naples Federico II | Cattarossi L.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Copetti R.,Latisana General Hospital
NeoReviews | Year: 2014

Lung ultrasound outperforms conventional radiology in the emergency diagnosis of pneumothorax and pleural effusions. Neonatologists and pediatricians are now adapting lung ultrasound to their specific clinical issues. The normal image is relatively unchanged throughout the age span, whereas progressively fading B-lines (comet-tail artifacts) describe the fluid-to-air transition of the neonatal lung. Also, an homogeneous white (hyperechogenic) lung with pleural image abnormalities and absence of spared areas is accurate in diagnosing respiratory distress syndrome. The evidence of bilateral confluent B-lines in the dependent areas of the lung ("white lung") and normal or near-normal appearance of the lung in the superior fields is highly sensitive and specific for transient tachypnea of the newborn. Infantile pneumonia has recently been proved to be accurately diagnosed by ultrasound after a short training period. In summary, chest ultrasonography is not yet ready to replace conventional chest radiology. However, when appropriately applied, a lung ultrasound scan can save time and radiation exposure to achieve a critical diagnosis. © 2014 by the American Academy of Pediatrics. All rights reserved.


Skrap M.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Mondani M.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Tomasino B.,IRCCS E. Medea | Weis L.,Italian Institute of Technology | And 6 more authors.
Neurosurgery | Year: 2012

BACKGROUND: Despite intraoperative technical improvements, the insula remains a challenging area for surgery because of its critical relationships with vascular and neurophysiological functional structures. OBJECTIVE: To retrospectively investigate the morbidity profile in insular nonenhancing gliomas, with special emphasis on volumetric analysis of tumoral resection. METHODS: From 2000 to 2010, 66 patients underwent surgery. All surgical procedures were conducted under cortical-subcortical stimulation and neurophysiological monitoring. Volumetric scan analysis was applied on T2-weighted magnetic resonance images (MRIs) to establish preoperative and postoperative tumoral volume. RESULTS: The median preoperative tumor volume was 108 cm. The median extent of resection was 80%. The median follow-up was 4.3 years. An immediate postoperative worsening was detected in 33.4% of cases; a definitive worsening resulted in 6% of cases. Patients with extent of resection of > 90% had an estimated 5-year overall survival rate of 92%, whereas those with extent of resection between 70% and 90% had a 5-year overall survival rate of 82% (P <.001). The difference between preoperative tumoral volumes on T2-weighted MRI and on postcontrast T1-weighted MRI ([T2-T1] MRI volume) was computed to evaluate the role of the diffusive tumoral growing pattern on overall survival. Patients with preoperative volumetric difference < 30 cm demonstrated a 5-year overall survival rate of 92%, whereas those with a difference of > 30 cm had a 5-year overall survival rate of 57% (P =.02). CONCLUSION: With intraoperative cortico-subcortical mapping and neurophysiological monitoring, a major resection is possible with an acceptable risk and a significant result in the follow-up. Copyright © 2011 by the Congress of Neurological Surgeons.


Ius T.,Azienda Ospedaliero Universitaria Santa Maria Della Misericordia | Ius T.,Italian Institute of Technology | Isola M.,University of Udine | Budai R.,Azienda Ospedaliero Universitaria Santa Maria Della Misericordia | And 5 more authors.
Journal of Neurosurgery | Year: 2012

Object. A growing number of published studies have recently demonstrated the role of resection in overall survival (OS) for patients with gliomas. In this retrospective study, the authors objectively investigated the role of the extent of resection (EOR) in OS in patients with low-grade gliomas (LGGs). Methods. Between 1998 and 2011, 190 patients underwent surgery for LGGs. All surgical procedures were conducted under corticosubcortical stimulation. The EOR was established by analyzing the pre- and postoperative volumes of the gliomas on T2-weighted MRI studies. The difference between the preoperative tumor volumes was also investigated by measuring the volumetric difference between the T2- and T1-weighted MRI images (ΔVT2T1) to evaluate how the diffusive tumor-growing pattern affected the EOR achieved. Results. The median preoperative tumor volume was 55 cm3, and in almost half of the patients the EOR was greater than 90%. In this study, patients with an EOR of 90% or greater had an estimated 5-year OS rate of 93%, those with EOR between 70% and 89% had a 5-year OS rate of 84%, and those with EOR less than 70% had a 5-year OS rate of 41% (p < 0.001). New postoperative deficits were noted in 43.7% of cases, while permanent deficits occurred in 3.16% of cases. There were 41 deaths (21.6%), and the median follow-up was 4.7 years. A further volumetric analysis was also conducted to compare 2 different intraoperative protocols (Series 1 [intraoperative electrical stimulation alone] vs Series 2 [intraoperative stimulation plus overlap of functional MRI/fiber tracking diffusion tensor imaging data on a neuronavigation system]). Patients in Series 1 had a median EOR of 77%, while those in Series 2 had a median EOR of 90% (p = 0.0001). Multivariate analysis showed that OS is influenced not only by EOR (p = 0.001) but also by age (p = 0.003), histological subtype (p = 0.005), and the ΔVT2T1 value (p < 0.0001). Progression-free survival is similarly influenced by histological subtype (fibrillary astrocytoma, p = 0.003), EOR (p < 0.0001), and ΔVT2T1 value (p < 0.0001), as is malignant progression-free survival (p = 0.003, p < 0.0001, and p < 0.0001, respectively). Finally, the study shows that the higher the ΔVT2T1 value, the less extensive the currently possible resection, highlighting an apparent correlation between the ΔVT2T1 value itself and EOR (p < 0.0001). Conclusions. The EOR and the ΔVT2T1 values are the strongest independent predictors in improving OS as well as in delaying tumor progression and malignant transformation. Furthermore, the ΔVT2T1 value may be useful as a predictive index for EOR. Finally, due to intraoperative corticosubcortical mapping and the overlap of functional data on the neuronavigation system, major resection is possible with an acceptable risk and a significant increase in expected OS.


Salvetat M.L.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Zeppieri M.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Tosoni C.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Brusini P.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia
Acta Ophthalmologica | Year: 2014

Purpose: To evaluate the repeatability and accuracy of the applanation resonance tonometer (ART) used in the automatic servo-controlled version, and to evaluate the influence of central corneal thickness (CCT) on the ART intraocular pressure (IOP) measurements. Methods: This prospective, randomized, single-centre study included one eye of 153 subjects (35 healthy volunteers and 118 patients with glaucoma). All participants underwent ultrasonic CCT measurement, followed by IOP evaluation with Goldmann applanation tonometer (GAT) and ART in random order. A single operator measured the IOP with each tonometer three times. Intra-examiner variability was evaluated using the coefficient of variation (CoV), intraclass correlation coefficient (ICC) and test-retest differences. Intermethod agreement was assessed using the Bland-Altman method. Linear regression analysis was used to evaluate the relationship between IOP measurements and CCT. Results: The mean IOP was 17.7 ± 4.4 mmHg with GAT and 20.6 ± 5.3 mmHg with ART (p < 0.001). CoV and ICC were, respectively, 5 ± 3% and 0.99 for GAT, and 8 ± 4% and 0.96 for ART (intermethods differences, p = 0.001). The ART test-retest differences significantly increased with increasing mean IOP (p = 0.003). The mean IOP difference (ART minus GAT) was 3.0 ± 4.0 mmHg, which increased with increasing mean IOP (p < 0.001). Both GAT IOP and ART IOP readings were significantly directly related to the CCT values (p = 0.03 and p = 0.004, respectively; intermethods difference, p = 0.32). Conclusions: The ART intra-examiner repeatability was excellent, although significantly lower than that of GAT, and decreased at higher IOP levels. ART significantly overestimated GAT IOP measurements, especially at higher IOP range. Both GAT and ART appeared similarly influenced by CCT value. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.


Shallice T.,International School for Advanced Studies | Shallice T.,University College London | Mussoni A.,International School for Advanced Studies | D'Agostino S.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Skrap M.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia
Cortex | Year: 2010

It is standardly believed that the localisation of cognitive function by means of impairments arising from cortical tumour is not possible as the functional defects that result are mild and unspecific. These assumptions were not supported in an investigation of four processes generally sensitive to right posterior cortical lesions, when patients with parieto-occipital lesions were compared with prefrontal ones. In three of the tests loading on the individual processes - Reaching Accuracy, Star Cancellation, Fragmented Letters and Cube Analysis - parieto-occipital impairments were found in the basic groups analysis and this was so in the right-hemisphere group. More critically, in these tests Lesion Behaviour Mapping showed the critical lesion site for the tests to have relatively little overlap with those of the other tests, indicating that the cognitive effects were not widespread and diffuse. In addition, in three of the tests the critical lesion sites fitted localisations arrived from other procedures. Patients with high-grade tumours performed considerably worse than those with low-grade tumours in only two of the tests (Star Cancellation, Cube Analysis) particularly in the right parieto-occipital group. In three (Reaching Accuracy, Star Cancellation, Cube Analysis) there was a deterioration with the operation specifically in the low-grade tumour patients. It is suggested that a tumour patient series may provide converging evidence for the localisation of a function initially obtained by some other procedure. © 2010 Elsevier Srl.


Salvetat M.L.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Zeppieri M.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Tosoni C.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Felletti M.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | And 2 more authors.
Journal of Glaucoma | Year: 2015

Purpose: To evaluate precision and accuracy of Corvis-ST, a new noncontact tonometer equipped with a high-speed Scheimpflug technology, which measures intraocular pressure (IOP), central corneal thickness (CCT), and corneal deformation parameters (CDPs). Relationships among IOP, CCT, and CDPs were also assessed. Materials and Methods: This prospective, randomized study included 1 eye of 164 subjects (79 controls and 85 glaucoma patients), which underwent IOP measurements taken 3 times with Goldmann applanation tonometry (GAT) and Corvis-ST in random order. Precision was evaluated using intraclass correlation coefficients. Intermethod agreement was assessed using Bland- Altman method. Relationships amongst IOP, CCT and CDPs were evaluated using linear regression analysis. Results: Corvis-ST intraclass correlation coefficients ranged between 0.95 and 0.99 for IOP and CCT; between 0.17 and 0.97 for CDPs. Mean (GATCorvis-ST) IOP was 1.4±2.7mm Hg, which appeared related to IOP and CDPs (P<0.05). CDPs significantly differed between glaucoma patients and controls (P<0.05). GAT and Corvis-ST IOP was related to CCT (P<0.05) and CDPs (P<0.001). Conclusions: Corvis-ST precision was excellent for IOP and CCT; moderate for CDPs. Corvis-ST underestimated GAT IOP, especially at higher IOP and at lower corneal deformability levels. GAT and Corvis-ST IOP increased in thicker and less deformable corneas. Glaucoma patients showed significantly less deformable corneas than controls. © 2014 Wolters Kluwer Health, Inc. All rights reserved.


Brusa G.,University of Udine | Savoia M.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Vergine M.,University of Udine | Bon A.,University of Udine | And 2 more authors.
Journal of Ultrasound in Medicine | Year: 2015

Objectives-To assess the reliability of lung sonography in neonates between physician interpreters with different degrees of experience. Methods-We retrospectively reviewed lung sonograms from neonates admitted to a neonatal intensive care unit with respiratory distress in the first 24 hours of life. The first scans were selected; only patients with available video clips documenting both hemithoraxes were included. The clips were independently examined by 4 different experienced observers blinded to clinical data. The interpreting physicians made a codified sonographic diagnosis, and the Cohen κ coefficient was used to measure the reliability between a proven experienced main interpreter and expert (κ1), intermediate (κ2), and beginner (κ3) control interpreters. We also calculated the specific agreement on respiratory distress syndrome and transient tachypnea of the neonate. Results-Four hundred sixty-five clips were taken from 114 neonates examined over a 16-month period. The patients' median gestational age (range) was 34 weeks (25-41 weeks), and the median birth weight (range) was 2085 g (608-4134 g). Eighty-eight percent of examinations were performed within 24 hours after birth. The overall κ coefficients (95% confidence intervals) were κ1 = 0.94 (0.88-1.00); κ2 = 0.72 (0.61-0.83); and κ3 = 0.81 (0.71-0.90). For respiratory distress syndrome, κ1 = 0.94 (0.87-1.00); κ2 = 0.90 (0.81-0.99); and κ3 = 0.87 (0.78-0.97). For transient tachypnea of the neonate, κ1 = 0.95 (0.89-1.00); κ2 = 0.76 (0.64-0.88); and κ3 = 0.81 (0.70-0.91). Conclusions-In neonates with early respiratory distress, lung sonography has high interobserver agreement even between interpreters with varying levels of experience. © 2015 by the American Institute of Ultrasound in Medicine.


Salvetat M.L.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Zeppieri M.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Miani F.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | Parisi L.,Azienda Ospedaliero Universitaria Santa Maria della Misericordia | And 2 more authors.
Cornea | Year: 2011

PURPOSE:: To compare central corneal thickness (CCT) and endothelial cell density (ECD) with laser scanning confocal microscope Heidelberg Retina Tomograph (HRT) II Rostock Corneal Module and noncontact specular microscope Tomey EM-3000 and to assess intra- and interobserver agreement in normal corneas. METHODS:: This prospective study included 48 normals (69.6 ± 7.2 years, range: 55-80 years) who underwent CCT and ECD with both Tomey and HRT 3 times by 2 independent observers. Measurement differences between instruments, agreement between devices, and test-retest variability (TRV) were determined. RESULTS:: Mean CCTs with Tomey and HRT were 529.4 ± 35.4 and 536 ± 37.6 μm (P = 0.06), respectively; average ECDs with Tomey and HRT were 2473.5 ± 242.2 and 2539.7 ± 338.6 cells per square millimeter (P = 0.04), respectively. The mean of the differences (HRT minus Tomey) was 6.5 ± 17 μm for CCT and 65 ± 135.1 cells per square millimeter for ECD. Differences between instruments were not related to CCT (P = 0.35), whereas significantly increased with increasing ECD (P = 0.0001). Intraexaminer TRV for Tomey and HRT were 3.9 ± 3.7 and 22.2 ± 18.4 μm for CCT and 73 ± 63.4 and 152.2 ± 148.4 cells per square millimeter for ECD, respectively; interexaminer TRV was 4.6 ± 4.2 and 23.8 ± 17.3 μm for CCT and 84.9 ± 72.3 and 159.8 ± 149.8 cells per square millimeter for ECD. CONCLUSIONS:: HRT II Rostock Corneal Module and the Tomey EM-3000 showed an overall good intermethod agreement. HRT showed a tendency to slightly overestimate CCT measurements, significantly underestimate ECD measurements in eyes with a reduced cell density (<2290 cells per square millimeter), and overestimate ECD in eyes with a high cell density. Both instruments showed low intra- and interobserver TRV for both CCT and ECD measurements, which tended to be less for Tomey.

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