Benedetto Torrisi

Study on unrecognized peripheral arterial disease (PAD) by ankle/brachial index and arterial comorbidity in Catania, Sicily, Italy.

Peripheral arterial disease (PAD) is under diagnosed and early diagnosis decreases consequences. We screened unrecognized PAD focusing on arterial co-morbidities. In the 3412 subjects, screened from 10 general practices in the city of Catania (Sicily, Italy), ankle brachial index (ABI) measurements were performed. An ABI ≤0.9 was considered as valid in diagnosing PAD. ABI value ≤0.9 was found in 2.3%, and a significant rate of carotid stenosis was also found Echocardiographic markers left ventricular diameter (LVD) >55 mm, interventricular septum (IVS) >11 mm, left ventricular diastolic volume (LVDV) was found > 100 ml), and ejection fraction (EF) was <50% were found with high frequency in those with ABI ≤0.9. Unrecognized PAD is lower compared with other findings but our prevalence resulted higher than other prevalence previously found by other study performed in Italy. Unrecognized PAD shows significant arterial co-morbidities and the ABI is a useful method to screen asymptomatic PAD.

Keratoconus Staging: A Computer-assisted Ultrabiomicroscopic Method Compared With Videokeratographic Analysis

Purpose The aim of this study was to introduce a new paradigm for keratoconus assessment, the keratoconus index (KI), generated from the ratio of peripheral corneal thickness (PCT) to the thinnest corneal thickness (TCT), and calculated by a computer-assisted procedure after ultrabiomicroscope (UBM) examination. Then we compared KI and the keratoconus severity index (KSI), obtained by videokeratography in patients with different stages of keratoconus. Methods We studied 60 eyes with different forms of keratoconus using the TMS-3 autotopographer, provided with a keratoconus screening program (using Smolek-Klyce methods) and the commercial version of the ultrasound biomicroscope (Paradigm UBM Plus Model P45) equipped with a 50-MHz probe, which was provided with our computer-assisted program. The proportion test Z and the correlation coefficient R were applied to the outcomes. Results The keratoconus severity index, KSI, obtained by color-coded videokeratographic maps, was in the range 95% to 32% (mean 52.22%). By means of UBM examination, we obtained 60 images and found values of TCT 0.278–0.592 mm and PCT 0.475–0.704 mm. Applying the computer-assisted method, we obtained values for KI of 1.112–2.159 (mean 1.428). Conclusions KI is correlated as well as KSI with the severity of the keratoconus (R = 0.76, P < 0.0001). It can be used as a similar parameter to measure the evolution of the disease, on the basis of corneal thickness rather than the curvature.

Correlation between quantity of silicone oil emulsified in the anterior chamber and high pressure in vitrectomized eyes.

Purpose To assess the existence of any correlation between the quantity of silicone oil emulsified in the anterior chamber and the incidence of high intraocular pressure in vitrectomized eyes. Methods Forty-nine eyes of 49 patients underwent vitrectomy with silicone oil injection as an adjuvant procedure. At the time of observation, between September 1999 and September 2000, 13 eyes (26.5%) were phakic; 23 eyes (47%) were pseudophakic; and 13 eyes (26.5%) were aphakic. Ultrasound biomicroscopy, slit-lamp biomicroscopy, and gonioscopy were performed to quantify the presence of silicone oil emulsified in the anterior chamber. Results The 13 phakic eyes did not have a high intraocular pressure. In 8 of the 13 eyes, ultrasound biomicroscopy detected only scarce oil emulsification in the anterior chamber (0.304 mm); in 5 of the 13 eyes, gonioscopy and ultrasound biomicroscopy did not detect anterior chamber oil emulsification. Fourteen of 23 pseudophakic eyes had a high intraocular pressure; of these, ultrasound biomicroscopy detected an abundant amount of anterior chamber oil emulsification (0.922 mm). Nine of 23 pseudophakic eyes did not have a high intraocular pressure; of these, ultrasound biomicroscopy detected little anterior chamber oil emulsification (0.209 mm). The 13 aphakic eyes had a high intraocular pressure; of these, ultrasound biomicroscopy detected an abundant amount of anterior chamber oil emulsification (0.795 mm). The coefficient of correlation for the measurements obtained was 0.98 (F = 62.3, P = 0.05;t = 11.1, P = 0.001). Conclusion This study showed a high correlation between the incidence of high intraocular pressure and the quantity of emulsified silicone oil in the anterior chamber.

Prevalence of high ankle–brachial index (ABI) in general population of Southern Italy, risk factor profiles and systemic cardiovascular co-morbidity: An epidemiological study

Many studies have been carried out to assess the prevalence, risk factors and co-morbidities of peripheral artery disease (PAD). By contrast, to date there is a lack of data on patients with high-ABI. This study aimed at estimating the prevalence of increased ABI (ABI>1.4) and to evaluate the involvement of traditional cardiovascular (CV) risk factors and the atherosclerotic burden (peripheral and carotid arteries) of these patients in a population of Southern Italy. We invited 9647 subjects, age ranging from 30 to 80, by letters to undergo an ABI measurement. Consequently, in patients with ABI>1.4, an ultrasound evaluation of the peripheral and carotid arteries was performed. An ABI>1.4 was found in 260 of 3412 subjects (7.6%). Statistically significant differences were reported in age, diabetes and hypertension, body mass index (BMI) and waist circumference (WC). No differences in sex distribution, dyslipidemia and smoke prevalence were observed. Moreover, 67.9% of ABI>1.4 patients showed a peripheral intima-media thickness (IMT)>0.9 mm; at linear regression it was correlated with ABI values; 25% of patients showed peripheral plaques. A carotid IMT>0.9 mm was reported in 78.6% of high-ABI patients and 32.1% were affected by atherosclerotic plaques. The observed increased-ABI prevalence of 7.6% was higher than previously reported. This was more prevalent in an older population with diabetes, hypertension and obesity. Moreover, these patients are characterized by an extended atherosclerotic involvement. Further studies are needed to clarify this evidence, a longitudinal observation of this clinical outcome, as we are performing, could provide a number of interesting elements.

A randomized prospective study of rhegmatogenous retinal detachment cases treated with cryopexy versus frequency-doubled Nd:YAG laser-retinopexy during episcleral surgery.

Purpose: To evaluate the efficacy of cryopexy versus transpupillary frequency-doubled (532 nm) Nd:YAG laser-retinopexy according to anatomic and functional success and postoperative complications. Methods: Seven hundred three patients with primary rhegmatogenous retinal detachment were enrolled. They underwent scleral-buckling surgery using randomly transpupillary frequency-doubled Nd:YAG laser or cryotherapy for retinopexy: patients were observed for a period of 6 months. The primary outcome was anatomic success at 6 months. Secondary outcomes included anterior segment complications, posterior segment complications, and postoperative visual acuity. Results: There was no significant difference between the primary and secondary outcomes in the two treatment groups: the anatomic success rate was 83% in the transpupillary frequency-doubled Nd:YAG laser group and 83.1% in the cryotherapy group; the rate of postoperative complications and the postoperative visual acuity results are also similar in the two groups; the only barely statistically significant difference (P = 0.045) was the rate of macular holes, which were present only in five myopic patients treated with transscleral cryopexy. Conclusion: Transpupillary frequency-doubled Nd:YAG laser retinopexy, as cryopexy, served as a safe and effective means of creating chorioretinal adhesion during retinal reattachment surgery. The rate of postoperative complications was not influenced by the type of retinopexy.

Changes in Visual Evoked Potentials During the Menstrual Cycle in Young Women

Purpose: Since, during the menstrual cycle, changes in neuronal activity and in auditory, olfactory, and taste thresholds were found, visual evoked potentials were investigated. Materials & Methods: In 50 healthy women the latency and the amplitude of P100 wave of pattern reversal visual evoked potentials were measured during the different menstrual phases (follicular, periovular, and luteal), as determined by sonography and serum progesterone level. Results: Compared with the follicular phase, during the luteal phase significant reduction in latency (101.29 ± 4.42 vs. 104.76 ± 5.02 ms, P < 0.01) and increase in amplitude (10.44 ± 3.15 vs. 8.62 ± 3.09 μ V, P < 0.05) were recorded. Conclusions: Fluctuations in ovarian steroid hormones affect the excitability of the visual system.

Correlation of optical coherence tomography pattern and visual recovery after vitrectomy with silicone oil for retinal detachment.

Purpose: To assess prospectively the features of the macular surface in silicone oil–filled eyes after surgery by analyzing whether silicone oil affects optical coherence tomography (OCT) measurements and their reproducibility and whether a statistical correlation exists between postoperative best-corrected visual acuity (BCVA) and foveal thickness measured by OCT. Methods: Twenty eyes of 20 patients underwent vitrectomy with silicone oil tamponade for retinal detachment. After vitrectomy, complete ophthalmic examination including determination of BCVA and OCT was performed to quantify the visual recovery and the foveal thickness. Results: Ophthalmoscopy revealed that the retina appeared to be reattached in all 20 eyes at 3 months after surgery. BCVA ranged from 0.4 logMAR to 1.7 logMAR, and foveal thickness ranged from 80 &mgr;m to 500 &mgr;m. Postoperative foveal thickness and BCVA had a strong correlation (r = 0.93; P = 0.003). Conclusion: The presence of silicone oil in the vitreous chamber does not change the reproducibility of OCT measurements of foveal thickness (coefficient of reproducibility, 1.48%). This study showed high statistical correlation between BCVA and foveal thickness. Therefore, postoperative BCVA is affected by postoperative foveal thickness, and visual improvement is limited in eyes with increased or decreased foveal thickness.

Can biliary carcinoembryonic antigen identify colorectal cancer patients with occult hepatic metastases

BackgroundTwenty-five percent of radically treated colorectal cancer patients already have occult hepatic metastases (OHM) that will later be observed during postoperative follow-up. Instrumental examinations, i.e., intraoperative ultrasound or Doppler perfusion index, have not improved diagnosis. As carcinoembyonic antigen (CEA) levels are useful to reveal hepatic metastases from colorectal cancer, determination of CEA in the bile rather than the blood may allow preclinical diagnosis of OHM thanks to the reduced volume of bile.MethodsOne hundred radically treated colorectal cancer patients were enrolled in the study. Bile was withdrawn from the gallbladder intraoperatively and biliary CEA levels determined using an immuno-enzymatic method (normal value 0–5 ng/ml). Eighty-nine fully evaluable patients were followed up for three years postoperatively to monitor hepatic metastases. Preoperative blood CEA, lymph node metastases and biliary CEA were compared in order to assess which procedure was more efficient in identifying patients who would develop hepatic metastases.ResultsEleven of the 89 evaluable patients developed hepatic metastases: 9/11 presented elevated biliary CEA levels (mean: 12.73; range: 5.1–26.2); 8/11 had high preoperative blood CEA values; and 9/11 were at anatomopathological stage N+. In the 78 patients who did not develop hepatic metastases, biliary CEA was within normal limits in 73/78, preoperative blood CEA was normal in 60/78, and 58/78 patients were at anatomopathological stage N−. Hence, the sensitivity of biliary CEA was 81.8%, specificity was 93.6%, and diagnostic accuracy was 92.1%.ConclusionsDetermination of biliary CEA seems to be more efficient in identifying patients presenting OHM who require frequent clinical examinations or adjuvant cancer treatment.

Italian Researchers Abroad: a Multivariate Analysis of Migration Trends

Few empirical studies have sought to ascertain the propensity with which Italian researchers return to Italy after a period spent abroad. Research into this question mainly draws on generalized databases (macro data), often with only dichotomous variables (returns vs. does not return). The main objective of the paper is to fill the information gap and to create a database of contacts of Italian researchers abroad, with a view to studying the brain drain in Italy and the propensity to return to the country of origin after a period spent abroad. Our main finding is that the propensity of Italian researchers to return to Italy is very low. This result is crucial to identify the effects of the brain drain in Italy: if the high-skilled migrant does not wish to return to his/her country of origin after acquiring knowhow abroad, migration effects are very likely to be detrimental to Italys economic and social growth. This finding leads into important policy implications: the Italian brain drain is not only due to wage differences offered by other countries, but it is caused by employment difficulties and other factors characterizing the job market and the Italian university system. It is not enough to carry out a salary review: an appropriate solution needs to be created to attract researchers and convert the brain drain into a brain exchange