Udine Hospital

Lauzacco, Italy

Udine Hospital

Lauzacco, Italy
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Defazio G.,University of Bari | Abbruzzese G.,University of Genoa | Aniello M.S.,University of Bari | Bloise M.,Sapineza University of Rome | And 12 more authors.
Neurology | Year: 2011

Background: Although environmental and genetic factors may contribute to the etiology of blepharospasm, their relative contribution in causing familial and sporadic blepharospasm is unknown. Methods: First-degree relatives of 122 patients with primary blepharospasm were examined with a validated 2-step diagnostic procedure, including a screening questionnaire and examination of some relatives. Examiners were blinded to the questionnaire data for family history of probands. Data for demographic and clinical features, prior ophthalmologic complaints, and nondecaffeinated coffee intake were collected from probands before family investigation. Results: Dystonia was diagnosed in 27 relatives from 23 families (20% rate of family history for dystonia). No significant differences were found between familial and sporadic cases in the frequency of coffee drinking and eye diseases or in sex, age at onset, or tendency to spread. Multivariable conditional logistic analysis testing of 67 case patients and 127 family-matched unaffected siblings yielded a significant positive association between blepharospasm and prior eye diseases (adjusted odds ratio [OR] 2.5; 95% confidence interval [CI] 1.1-6.1; p = 0.03) and a significant inverse association between case status and ever coffee drinking (adjusted OR 0.23; 95% CI 0.1-0.8; p = 0.02). Conclusions: The new information from this large family-based study on primary blepharospasm strongly supports eye diseases and coffee as risk factors for blepharospasm. The finding that the 2 environmental exposures exerted a similar influence on familial and sporadic blepharospasm, together with the convergent phenotypic expression in familial and sporadic cases, implies that familial and sporadic blepharospasm probably share a common etiologic background. © 2011 by AAN Enterprises, Inc.

Lionetti E.,University of Catania | Castellaneta S.,San Paolo Hospital | Pulvirenti A.,University of Catania | Tonutti E.,Udine Hospital | And 4 more authors.
Journal of Pediatrics | Year: 2012

Objective: To evaluate the frequency and the natural history of potential (serology positive/Marsh 0-1 histology) celiac disease (CD) in children with a family risk of CD and factors associated with potential instead of overt (serology positive/Marsh 2-3 histology) CD expression. Study design: Two-year follow-up study of 96 children (57 females; mean age: 29 ± 12 months) prospectively investigated from birth with: (1) a CD-affected first-degree relative; (2) positivity of serum IgA anti-tissue transglutaminase (tTG) or IgG antigliadin and IgA deficiency; and (3) the results of small intestinal biopsy. Children with potential CD were advised to remain on a gluten containing diet, repeat the celiac antibodies every 6 months, and to have an intestinal biopsy performed in case of persistently high anti-tTG level. Factors discriminating between potential and overt CD were analyzed by decision tree analysis based on the C4.5 algorithm. Results: Twenty-four children had potential and 72 overt CD. The stronger predictors of potential CD were lack of symptoms, anti-tTG level lower than 11-fold the upper normal limit, age lower than 24 months, and breastfeeding longer than 8 months. Eighteen out of 21 (86%) patients with potential CD continuing a gluten-containing diet became antibody negative, 1/21 (5%) developed overt CD, and 2/21 (9%) had fluctuating antibodies levels after 2 years. Conclusions: The prevalence of potential CD and the percentage of short-term loss of CD-related-antibodies are high in infants at-family-risk for CD. In symptomless children with a positive celiac serology, the decision of performing an intestinal biopsy should be preceded by a period of repeated serological testing. Copyright © 2012 Mosby Inc.

Antonello M.,University of Padua | Menegolo M.,University of Padua | Piazza M.,University of Padua | Bonfante L.,University of Padua | And 2 more authors.
Journal of Vascular Surgery | Year: 2013

Objective: Recent studies have shown that progressive renal dysfunction may develop in patients after endovascular aneurysm repair (EVAR). Data are conflicting about the effect of EVAR on renal function compared with open repair (OR). The purpose of this study was to compare the effects of EVAR, both with transrenal fixation (TRF) and infrarenal fixation (IRF), vs OR on renal function detected with renal perfusion scintigraphy (RPS). Methods: A prospective study was carried out from January 2003 to December 2007. Exclusion criteria included factors that could influence post-procedural renal function as: preoperative creatinine clearance level <65 mL/min for men and 60 mL/min for women, renal artery stenosis >60%, renal accessory artery planned to be covered by the endograft, single functioning kidney, hemodialysis, and kidney transplant. To evaluate renal function, an RPS was performed preoperatively, at 30 days, at 6 and 12 months, and then yearly. The glomerular filtration rate (GFR) was estimated with the Gates method. Results: During the study period, 403 patients were enrolled; 243 (60%) had OR and 160 (40%) EVAR; among these, 83 (51%) had a TRF and 77 (48%) an IRF; 55 patients were excluded from the study. No statistical differences were observed between groups for demographics and risk factors. Statistically significant differences emerged between OR and EVAR for early postoperative death (4% vs 0%; P =.01). Follow-up ranged from 54 to 126 months (mean, 76 months) for OR and from 54 to 124 months (mean, 74 months) for EVAR (P = NS). Kaplan-Meier analysis survival rate at 9 years was 70% for OR and 58% for EVAR with a risk of secondary procedure of 9% and 34%, respectively (P <.0001). A deterioration of the GFR was observed during the follow-up in both groups with a decrease after 9 years of 11% in the EVAR group and 3% in the OR group respective to baseline (P <.001). A remarkable difference emerged on renal function between EVAR patients who required a secondary procedure compared with the other EVAR patients (P <.005). No significant differences emerged between TFR and IRF for GFR decline during the follow-up period. Conclusions: After EVAR, there is a continuous decline in renal function with respect to OR, regardless of fixation level and independently of pre-existing renal insufficiency. The risk of GFR impairment after EVAR should be taken into consideration in selecting patients with preoperative renal insufficiency.© 2013 by the Society for Vascular Surgery.

Piazza M.,University of Padua | Menegolo M.,University of Padua | Ferrari A.,University of Padua | Bonvini S.,University of Padua | And 4 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2014

Objectives: The aim was to evaluate long-term outcomes and sac volume shrinkage after endovascular popliteal artery aneurysm repair (EVPAR). Methods: This study was a retrospective review of all EVPAR cases between 1999 and 2012. Sac volume shrinkage, long-term patency, limb salvage, and survival were evaluated using Kaplan-Meier estimates. The association of anatomical and clinical characteristics with patency was evaluated using multivariate analysis. Results: Forty-six EVPAR were carried out in 42 patients (mean age 78 years, 86% male; mean sac volume 45.5 ± 3.5 mL). In 93% of cases (n = 43) the procedure was elective, while in 7% of cases it was for rupture (n = 2) or acute thrombosis (n = 1). Of the 43 patients who underwent elective repair, 58% were asymptomatic and 42% symptomatic (14 claudication, 3 rest pain, and 1 compression symptoms). Technical success was 98%. Mean duration of follow-up was 56 ± 21 months. Primary patency at 1, 3, and 5 years was 82% (SE 2), 79% (SE 4), and 76% (SE 4), while secondary patency was 90% (SE 5), 85% (SE 4), and 82% (SE 1) respectively; at 5 years there was 98% limb salvage and an 84% survival rate. During follow-up 11 limbs had stent graft failure: six required conversion, one underwent amputation, and four continued with mild claudication. Of those with graft failure, 63% (7/11) occurred within the first year of follow-up. The mean aneurysm sac volume shrinkage between preoperative and 5-year post-procedure measurement was significant (45.5 ± 3.5 mL vs. 23.0 ± 5.0 mL; p <.001). Segment coverage >20 cm was a negative predictor for patency (HR 2.76; 95% CI 0.23; p =.032). Conclusions: EVPAR provides successful aneurysm exclusion with good long-term patency, excellent limb salvage, and survival rates. Close surveillance is nevertheless required, particularly during the first postoperative year. Patients requiring long segment coverage (>20 cm) may be at increased risk for failure. © 2014 European Society for Vascular Surgery.

Vidani A.C.,University of Udine | Chittaro L.,University of Udine | Carchietti E.,Udine Hospital
2nd International Conference on Games and Virtual Worlds for Serious Applications, VS-GAMES 2010 | Year: 2010

Serious games can help in training medical first responders by providing emergency simulations which are always available, safer and possibly cheaper than real-world simulations. However, serious games for training emergency medical services (EMS) nurses must take into account the familiarity of the users with 3D videogames, which could be very low. In this paper, we present a prototype of the serious game we are developing for training EMS nurses in decision making and the results of a user study we have carried out with its intended users. The main purposes of the study were to assess nurses' acceptance of this kind of application, as well as to collect suggestions and requirements from nurses. © 2010 IEEE.

Marrone G.,Udine Hospital | Rosso I.,Udine Hospital | Moretti R.,Udine Hospital | Valent F.,Udine Hospital | Romanello C.,Udine Hospital
European Journal of Nutrition | Year: 2012

Purpose: To assess vitamin D status in children aged 2-220 months in northeastern Italy (latitude 46°). Serum 25-hydroxyvitamin D (25OHD) concentration was assessed in 93 children afferent to the Pediatric Department of the Hospital of Udine. Methods: Vitamin D status was defined as follows: sufficient with serum 25OHD between 50 and 250 nmol/l (level 4); insufficient between 37.5 and 50 nmol/l (level 3); deficient less than 37.5 nmol/l (level 2); severely deficient if less than 12.5 nmol/l (level 1). We investigated the potential risk factors of vitamin D deficit. Results: We found that six children (6.4%) had level 1, 36 (38.7%) had level 2, 9 (9.7%) had level 3, and only 45.2% had sufficient level of 25OHD. Immigrate children had a higher risk for vitamin D deficiency if compared with Italians: 75% of non-Italian children had an insufficient 25OHD level compared with 47.0% of Italian children (p = 0.0036). There was a marked seasonal effect on 25OHD level: when plasma sample was withdrawn between November and May, only 29.4% of children showed sufficient vitamin D level, while 70.5% was insufficient (p < 0.0001). Among the obese children, 9.0% had sufficient level of 25OHD with 90% being deficient (p = 0.01). We did not find any significant difference in vitamin D status among children in different age groups. Conclusion: Vitamin D deficiency is common in children living in northeastern Italy. The risk factors were winter season for blood withdrawal, non-Caucasian race, and obesity. These high-risk groups should be targeted for screening and educated about the need of sunlight exposure. © Springer-Verlag 2011.

Lionetti E.,SIGENP Italian Society of Pediatric Gastroenterology | Lionetti E.,Marche Polytechnic University | Castellaneta S.,SIGENP Italian Society of Pediatric Gastroenterology | Castellaneta S.,University of Catania | And 35 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND The relationship between the risk of celiac disease and both the age at which gluten is introduced to a child's diet and a child's early dietary pattern is unclear. METHODS We randomly assigned 832 newborns who had a first-degree relative with celiac disease to the introduction of dietary gluten at 6 months (group A) or 12 months (group B). The HLA genotype was determined at 15 months of age, and serologic screening for celiac disease was evaluated at 15, 24, and 36 months and at 5, 8, and 10 years. Patients with positive serologic findings underwent intestinal biopsies. The primary outcome was the prevalence of celiac disease autoimmunity and of overt celiac disease among the children at 5 years of age. RESULTS Of the 707 participants who remained in the trial at 36 months, 553 had a standard-risk or high-risk HLA genotype and completed the study. At 2 years of age, significantly higher proportions of children in group A than in group B had celiac disease autoimmunity (16% vs. 7%, P = 0.002) and overt celiac disease (12% vs. 5%, P=0.01). At 5 years of age, the between-group differences were no longer significant for autoimmunity (21% in group A and 20% in group B, P = 0.59) or overt disease (16% and 16%, P=0.78 by the log-rank test). At 10 years, the risk of celiac disease autoimmunity was far higher among children with high-risk HLA than among those with standard-risk HLA (38% vs. 19%, P=0.001), as was the risk of overt celiac disease (26% vs. 16%, P=0.05). Other variables, including breast-feeding, were not associated with the development of celiac disease. CONCLUSIONS Neither the delayed introduction of gluten nor breast-feeding modified the risk of celiac disease among at-risk infants, although the later introduction of gluten was associated with a delayed onset of disease. A high-risk HLA genotype was an important predictor of disease. (Funded by the Fondazione Celiachia of the Italian Society for Celiac Disease; CELIPREV ClinicalTrials.gov number, NCT00639444.) Copyright © 2014 Massachusetts Medical Society.

Chittaro L.,University of Udine | Carchietti E.,Udine Hospital | De Marco L.,University of Udine | Zampa A.,Physical Medicine and Rehabilitation Institute Gervasutta
User Modeling and User-Adapted Interaction | Year: 2011

Being able to promptly and accurately choose a proper course of action in the field is a crucial aspect of emergency response. For this reason, emergency medical services (EMS) rely on well established procedures that apply to the most frequent cases first responders encounter in their practice, but do not include special cases concerning (sensory, motor or cognitive) disabled persons. In these cases, first responders may end up applying suboptimal or possibly wrong procedures or lose precious time trying to adapt on-the-fly to the special case. This paper proposes both (i) a detailed patient model for EMS that can account for peculiar aspects of the many existing disabilities and (ii) an adaptive information system called PRESYDIUM (Personalized Emergency System for Disabled Humans) that provides tailored instructions in the field for helping medical first responders in dealing with disabled persons. More precisely, we will illustrate and discuss: (i) the design and development process of PRESYDIUM, (ii) the patient model, which is partly based on the ICF (International Classification of Functioning, Disability and Health) standard proposed by the World Health Organization, (iii) the knowledge base used by the system to provide tailored instructions to medical first responders, (iv) the Web-based architecture of the system, (v) the different interfaces-including one for mobile devices-the system provides to enable all the identified stakeholders (disabled persons, their families, clinicians, EMS call center operators, medical first responders) to easily access and possibly provide data to the system, (vi) the evaluation of the validity of the patient model and of the system usability which has been conducted with end users. © 2010 Springer Science+Business Media B.V.

Piazza M.,University of Padua | Frigatti P.,Udine Hospital | Scrivere P.,University of Padua | Bonvini S.,University of Padua | And 4 more authors.
Journal of Vascular Surgery | Year: 2013

Objective: The goal of this study was to evaluate the role of intraoperative aneurysm sac embolization during endovascular aneurysm repair (EVAR) using a standard dose of coils and fibrin glue in the prevention of type II endoleak (EII). Methods: Two groups were compared: 83 patients underwent standard EVAR during the period 2008-2009 (group A) and 79 patients underwent EVAR during the period 2010-2011 (group B). Computed tomography scans were evaluated with Osirix Pro 4.0 software to obtain aneurysm sac volume. EII rates at the first computed tomography scan follow-up, as well as midterm freedom from EII and freedom from related reintervention, were compared. Preoperative number of patent aortic side branches (inferior mesenteric artery, lumbar arteries, accessory renal arteries), sac thrombus, and sac volume were evaluated for their association with EII in the two groups using multiple logistic regressions. Results: Patient characteristics, Society for Vascular Surgery comorbidity scores (0.85 ± 0.44 vs 0.82 ± 0.46; P =.96), and operative time (185 ± 52 vs 179 ± 49; P =.92) were similar for groups A and B. The first computed tomography scan (≤3 months) revealed a significantly larger number of EIIs in group A than in group B (23% vs 10%; P =.02). Spontaneous EII resolution occurred in 65% of patients in group A and in 79% in group B (P = 1.0), whereas sac volume increased in 25% and 10% (P =.63) of cases, respectively. At 18 months (range, 6 months to 4.4 years), overall mean differences in sac volume shrinkage (27 ± 12 cm3 vs 25 ± 12 cm3; P =.19) and freedom from EII (92% vs 96%; P =.33) were similar, whereas freedom from reintervention was significantly lower in group A (93% vs 99%; P =.03) than in group B. Multivariate analysis showed preoperative aneurysm sac volume >125 cm3 to be the only independent significant predictor of EII (odds ratio, 4.0; 95% confidence interval, 1.5-10.5; P =.005). Conclusions: Although further confirmatory studies are needed, sac embolization during EVAR may be a valid approach to preventing EII and its complications during short- and midterm follow-up. More aggressive intraoperative embolization should be considered for patients with a preoperative aneurysm sac volume >125 cm3.

Trento M.,University of Turin | Gamba S.,Maria Vittoria Hospital | Gentile L.,Unit for Diabetes and Metabolic Diseases ASL 19 | Grassi G.,University of Turin | And 8 more authors.
Diabetes Care | Year: 2010

OBJECTIVE - A trial was performed to establish whether our group care model for lifestyle intervention in type 2 diabetes can be exported to other clinics. RESEARCH DESIGN AND METHODS - This study was a 4-year, two-armed, multicenter controlled trial in 13 hospital-based diabetes clinics in Italy (current controlled trials no. ISRCTN19509463). A total of 815 non-insulin-treated patients aged <80 years with ≥1 year known diabetes duration were randomized to either group or individual care. RESULTS - After 4 years, patients in group care had lower A1C, total cholesterol, LDL cholesterol, triglycerides, systolic and diastolic blood pressure, BMI, and serum creatinine and higher HDL cholesterol (P < 0.001, for all) than control subjects receiving individual care, despite similar pharmacological prescriptions. Health behaviors, quality of life, and knowledge of diabetes had become better in group care patients than in control subjects (P<0.001, for all). CONCLUSIONS - The favorable clinical, cognitive, and psychological outcomes of group care can be reproduced in different clinical settings. © 2010 by the American Diabetes Association.

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