Paola Garancini

Excimer laser photorefractive keratectomy for myopia: results in 1165 eyes

BACKGROUND We report the results of a prospective study conducted in Italy to evaluate the efficacy, safety, predictability, and complications of excimer laser photorefractive keratectomy for the correction of myopia. METHODS. Photorefractive keratectomy was performed on 1236 myopic sighted eyes in 16 centers, using the Summit Excimed 193 nm excimer laser. The attempted correction ranged from -0.80 to -25.00 diopters (mean, -7.83 +/- 3.88 D). The population was divided into three groups of attempted correction: between -0.80 and -6.00 D, between -6.10 and -9.90 D, and between -10.00 and -25.00 D. We report the data of 1165 eyes at 1 month, 970 eyes at 3 months, 752 at 6 months, and 330 at 12 months. At each visit, we evaluated (1) the refractive changes over time; (2) the difference between attempted and achieved correction; (3) uncorrected and best spectacle corrected visual acuity; and (4) haze. RESULTS Twelve months after surgery, the spherical equivalent refractive error in 146 eyes with attempted correction of -0.80 to -6.00 D was -0.52 +/- 1.04 D; 104 eyes (71.2%) were within +/- 1.00 D of attempted correction. In 145 eyes with attempted correction of -6.10 to -9.90 D, the spherical equivalent refractive error was -1.66 +/- 1.88 D; 50 eyes (34.5%) were within +/- 1.00 D of attempted correction. The spherical equivalent refractive error in 39 eyes with attempted correction of -10.00 to -25.00 D was -1.86 +/- 3.47 D; 11 eyes (28.2%) were within +/- 1.00 D of attempted correction. Eight eyes (2.4%) lost two or more Snellen lines of best spectacle corrected visual acuity. None of the treatments caused severe postoperative complications, or scarring. CONCLUSIONS Photorefractive keratectomy proved safe and effective, but highly predictable only in the correction of myopia up to -6.00 D.

Incidence and prevalence rates of diabetes mellitus in Italy from routine data: a methodological assessment.

This study was undertaken to identify and validate possible existing sources of information to estimate the prevalence of known diabetes and the incidence of Type I (insulin-dependent) diabetes in Italy.The prevalence of known diabetes was estimated on the basis of data on drug sale, using specific defined daily doses as index of drug consumption. The estimation of the average daily dose used for calculations was carried out on a consecutive series of 911 diabetic subjects from two outpatient clinics.The incidence of Type 1 (insulin-dependent) diabetes was obtained by processing data routinely collected by the Regional Health Services, related to hospital discharge diagnosis records mentioning diabetes mellitus. The validation was carried out in 12 hospitals of the same Region. The estimated prevalence rate of known diabetes was 1.7%, including patients on dietary treatment.In the Lombardia Region in 1982–83 the estimated annual average incidence of Type I (insulin-dependent) diabetes, under the age of 35 was 4.6/100,000. This rate appears much lower then that observed in Northern Europe and the United States while it is similar to the French rate. This is in agreement with the findings of studies showing changes with latitude of the incidence rates of Type 1 (insulin-dependent) diabetes.

Microalbuminuria and its associated risk factors in a representative sample of Italian Type II diabetics

A multicenter population-based study was undertaken from 1983 to 1985 in 12 diabetes centers in Lombardy, in order to assess the prevalence of microalbuminuria and clinical proteinuria. Out of a total population of 17,704 diabetics, 1,155 were randomly selected within four strata of duration of disease and albumin excretion rate (AER) assessment was carried out in 541 unselected subjects. Albuminuria was evaluated from an overnight urine collection using a radioimmunoassay. The overall prevalence rates were 25.8% for microalbuminuria (30 less than or equal to AER less than 350 micrograms/min) and 3.0% for macroalbuminuria (AER less than or equal to 350 micrograms/min). In Type II diabetes the rate of microalbuminuria increases with duration of disease up to 10 years and then tends to level off. This could be due to the existence of two subgroups of diabetics with different life expectancy and different degree of risk of nephropathy. The Italian prevalence of microalbuminuria appears to be rather similar to that of other studies, while the prevalence of macroalbuminuria is quite low with respect to middle and northern Europe, indicating a rather slow rate of progression to clinical proteinuria. This could be explained on the basis of differing protein intakes. The cases with AER greater than or equal to 30 micrograms/min, greater than or equal to 70 micrograms/min, and greater than or equal to 350 micrograms/min have been compared with matched diabetic controls with AER less than or equal to 15 micrograms/min.(ABSTRACT TRUNCATED AT 250 WORDS)

Identification of the cohort of type 1 diabetes presenting in Lombardy in 1983-84: a validated assessment.

An incidence register for Type 1 diabetes was started in Lombardy in 1983–84 for people under 35 years of age. The main information source was the Regional Health Service record system, which provides anonymous reports on all patients discharged from public and private hospitals. Great care was taken to assure the quality of the data in the register. The clinical diagnosis was validated by examining the case notes. Completeness of the register was assessed using multiple independent sources of case ascertainment such as the list of the Youth Diabetics Association, the files of three hospital endocrinology centres, and the registry of conscripts rejected because of diabetes. The estimated age‐adjusted (world standard) annual incidence rate was 6.04 per 100 000 in the group 0–18 years and 5.96 per 100 000 in the age group 0–14 years. Females had peak incidence at 11 years of age, males had peak incidence 2 years later. These results confirm the low occurrence of Type 1 diabetes in northern Italy. A seasonal variation in onset of Type 1 diabetes was seen.

Prevalence of retinopathy in diabetic subjects from out-patient clinics in Lombardy (Italy), and associated risk factors A multicentre epidemiologic study

There is little information on the prevalence of diabetic complications in Italy. For this reason, a multicentre population-based study was carried out in 1983-1985 in 12 representative out-patient clinics for the treatment of diabetes in the Lombardy region. Out of a total population of 17,704 patients 1160 diabetic subjects were randomly selected within strata based on their duration of disease (less than or equal to 5; 6-10; 11-20; greater than 20 years). Eight hundred and thirty-eight responders were examined using standardised protocols. The estimated prevalences (adjusted for duration of disease) for the total population involved in the study were 29.7% and 7.6% for background and proliferative retinopathy respectively. The overall standardised rates were higher in insulin-dependent diabetes mellitus (IDDM) (53.6%) than in non-insulin-dependent diabetes mellitus (NIDDM) (34.7%) for both background (41.1%, 28.4% respectively) and proliferative (12.5%, 6.2% respectively) retinopathy, and increased with the duration of disease. The analysis of the relationship between diabetic retinopathy and the calculated risk factors did not show any association with hypertension or metabolic control, except for post-prandial blood glucose in subjects with durations 6-10 and greater than 20 years; an association with azotaemia was found in subjects with durations less than or equal to 5 and 11-20 years. Diabetic retinopathy appeared to be independently associated with the type of treatment and not with the type of diabetes, metabolic control, or hypertension.

Lessons from in vitro perifusion of pancreatic islets isolated from 80 human pancreases.

We report the average insulin response to acute glucose measured by in vitro perifusion of pancreatic islets isolated from 80 consecutive human organs. Different perifusion parameters were considered [basal release, stimulation index (SI), time to peak, incremental area under the curve Δ-AUCa)], and the correlation among them was determined. SI positively correlated with Δ-AUCa (p < 0.001, r = 0.80) while negatively with time to peak (p < 0.05, r = −0.23). We also evaluated several variables of the isolation procedure that might affect responsiveness to glucose by human islets. Sex and age of pancreas donors, cold ischemia time, duration of the digestion, collagenase concentration, and lot characteristics (collagenase, trypsin, clostripain, and proteases activity), and final islet yield were considered. Multivariate regression analysis showed only an independent association between SI and the concentration of collagenase (p = 0.01).

CT-Guided Pancreatic Percutaneous Fine-Needle Biopsy in Differential Diagnosis between Pancreatic Cancer and Chronic Pancreatitis

Differential diagnosis between pancreatic cancer and chronic pancreatitis is still difficult to establish. In 63 patients with suspected pancreatic neoplasm we performed: serum CA 19-9 assessment, abdominal ultrasound, CT scan and CT-guided pancreatic percutaneous fine-needle biopsy. The conclusive diagnosis was pancreatic cancer in 40 patients and chronic pancreatitis in 23 patients. With regard to the differential diagnosis, sensitivity and specificity were respectively 80% and 78% for serum CA 19-9, 75% and 65% for abdominal US, 85% and 70% for CT scan, 00% and 87% for percutaneous fine-needle biopsy. We conclude that CT-guided percutaneous fine-needle biopsy is the most reliable method for differential diagnosis between pancreatic cancer and chronic pancreatitis.

Relevance of HLA-DR Phenotype and Breast-Feeding Status in Age Heterogeneity at IDDM Onset

autoantibody by periodical measurement of thyroid-stimulating hormone also was recommended. We have been following a group of Chinese children with IDDM. Routine screening during follow-up revealed no cases of thyroid abnormality nor the presence of thyroid autoantibodies. Twenty-six IDDM patients are being followed at the pediatric department of the Prince of Wales Hospital. All patients (10 boys and 16 girls) are of southern Chinese origin. The mean age of onset was 7.9 yr (range 1.7-13.5 yr.) All patients presented with typical symptoms of diabetes including polyuria, polydipsia, and weight loss. Laboratory testing of all patients at diagnosis revealed glucosuria, ketonuria, and random plasma glucose > 11.1 mM. Their illness is, therefore, classified as IDDM as defined by the National Diabetes Data Group. Six patients (23%) presented with diabetic ketoacidosis at diagnosis. The mean ± SD duration of follow-up was 4.0 ± 1.6 yr (range 1.0-7.0 yr). In 1991, the mean HbAlc was 8.1 ± 1.4%, with a range of 5.6-10.6% (normal reference range 5.1-6.4%). Since 1989, antibodies to thyroid microsomal antigen and thyroglobulin determined by hemagglutination (Thymune-M and Thymune-T, Wellcome, Dartford, UK), and sensitive thyroid-stimulating hormone determined by a two-site chemiluminometric immunoassay (Magic Lite TSH, Ciba Corning, Halstead, UK) were checked annually in all IDDM patients. None of the patients was found to have thyroid autoantibodies. All thyrotropin levels checked were within the normal reference range (0.3-4.0 jxU/L). During the follow-up period, all patients were checked for the presence of goiter at each visit. None of our patients was found to have goiter.

First degree family history of diabetes and risk factors for cardiovascular disease in non-diabetic subjects in the National Telephone Company: A metabolic survey

The effect of first degree family history of diabetes on known risk factors for cardiovascular disease was evaluated in 4989 non-diabetic employees of the Italian Telephone Company. Family history of diabetes was present in 759 subjects (476 males and 283 females); in these subjects body mass index, diastolic blood pressure, blood glucose levels (fasting and one and two-hour post-load), triglyceride and cholesterol levels were significantly higher than in age and sex-matched controls. In different age groups (<30, 31–40, 41–50, >50 years) the effect of first degree family history of diabetes was evaluated after stratification by sex. In males with first degree family history of diabetes; this effect was strongest in the under 30 age group: body mass indices, systolic and diastolic blood pressures, fasting and two-hour post-load blood glucose levels, triklyceride and cholesterol levels were all significantly higher than in subjects with negative family history of diabetes. These differences between subjects with negative and positive family histories declined with age and disappeared in subjects over 50.In females the effect of familial diabetes was weaker and delayed for body mass index and one hour blood glucose, appearing only in subjects over 30.Multiple logistic analysis indicated that only body mass index and one-hour blood glucose levels were independently associated with positive family history of diabetes. The differences observed between males and females in the youngest age group were also confirmed by this analysis. These data may indicate a multifactorial genetic link leading to increased cardiovascular morbidity in subjects with diabetes.