Salvatore Amico - Academia.edu (original) (raw)

Uploads

Papers by Salvatore Amico

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new second-line medication in the managem... more Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new second-line medication in the management of hyperglycemia in type 2 diabetes. These drugs can be associated with the development of diabetic ketoacidosis (DKA) with normal or moderately increased blood glucose levels. This is a life-threatening clinical condition termed euglycemic DKA, of which the diagnosis can be delayed due to the relative euglycemia. We report on two patients with type 2 diabetes who presented to the Emergency Department with malaise, nausea and vomiting. Both patients had been taking dapagliflozin for at least six months. A risk factor for the development of ketoacidosis, namely heavy alcohol consumption, was found in one of the patients. Arterial blood gas analysis showed severe metabolic acidosis with increased anion gap, positive serum and urine ketones and normal arterial lactate. The patients were treated in Internal Medicine with intravenous fluids, insulin, sodium bicarbonate and potassium. Dapa...

Minerva cardioangiologica, 2006

Pulmonary thromboembolism is a relatively common disease in an Emergency Department. Diagnosis, o... more Pulmonary thromboembolism is a relatively common disease in an Emergency Department. Diagnosis, often difficult, is based on careful evaluation of risk factors, clinical examination, radiological and laboratory investigations. Plasma D-dimer, a degradation product of cross-linked fibrin with low specificity and very high sensibility, is considered extremely useful as screening to rule out a pulmonary thromboembolism. We report the case of a 74 year old woman who presented in the Emergency Department suffering from the sudden onset of dyspnea 4 hours before. Plasma D-dimer (automated latex-enhanced turbidimetric test) was normal (253 ng/mL; normal value: 278 ng/mL), but spiral CT angiography showed a sub-massive thromboembolism of the principal branch of the right pulmonary artery, also involving the middle and the inferior lobar branches. A cardiac echo-color-Doppler demonstrated an enlargement of the right cardiac section with telediastolic pressure in the pulmonary artery of 74 mm...

European Journal of Internal Medicine, 2006

A right bundle branch block with ST-segment elevation in the V 1-V 3 leads in characteristic cove... more A right bundle branch block with ST-segment elevation in the V 1-V 3 leads in characteristic coved or saddleback configuration may be encountered as an incidental finding. However, not all patients with a Brugada-like electrocardiographic pattern are affected by the Brugada syndrome; in fact, this pattern may also be found in healthy individuals. Whether symptomatic patients affected by the syndrome are at a high risk of developing life-threatening ventricular arrhythmias and should immediately receive an automatic, implantable defibrillator is open to debate, as is the clinical management of asymptomatic patients, because data from the scientific literature are controversial. Implications of the diagnosis and the treatment of this category of patients are discussed.

European Heart Journal, 2001

We describe a case of acute poisoning in a 51-year-old female patient who presented to the Emerge... more We describe a case of acute poisoning in a 51-year-old female patient who presented to the Emergency Depart-ment with weakness, anxiety, dry mouth, bilateral mydriasis and lid drop. In differential diagnosis, botulism, Guillain– Barre ́ syndrome and myasthenia gravis were considered, as well as cerebral haematoma because of a cranial injury a week before. Symptoms, which resolved within 12h without any therapy, were instead related to the ingestion of lupin seeds. European Journal of Emergency Medicine

Italian Journal of Medicine

Internal and Emergency Medicine

We describe the case of a 54-year-old man admitted to the ED because of a sudden sharp pain in th... more We describe the case of a 54-year-old man admitted to the ED because of a sudden sharp pain in the dorsal spine radiating bilaterally to the abdomen. At the time of onset the patient was at rest, and there was no history of any kind of trauma. The intensity of the pain was constant, and was not exacerbated by movements of the spinal column, deep inspiration or coughing. There was no dysuria or other urinary tract symptoms. Physical examination of the abdomen was normal. The femoral pulses were normal. The back examination did not show tenderness to palpation of the spinous process, muscle spasm or deformity. Arterial blood pressure (B.P.) was 140/80 mmHg, heart rate 88 beats/min. An electrocardiogram showed a sinus rhythm without abnormalities of ventricular repolarisation. In differential diagnosis, we first considered the possibility of an aortic dissection. We therefore obtained an angiocomputed tomography (angio-CT), which excluded this possibility. Acute pancreatitis was also ruled out by normal values of amylase and lipase, and a CT scan of the spinal column showed no spontaneous vertebral fractures. With concern for a vascular spinal emergency, a magnetic resonance imaging (MRI) was performed, which showed an epidural haematoma at level T10–T12 compressing the spinal cord (Fig. 1), not visible on the CT scan. According to the National Acute Spinal Cord Injury Study (NASCIS), the patient was treated with 30 mg/kg IV of methylprednisolone, and then referred to a neurosurgical unit [1]. Neurological deficit followed the onset of the back pain two hours later, with proximal paresis grade 4/5 according to the British Medical Research Council Scale (BMRC), radicular hypoaesthesia (T12) of left leg and bilateral hyperreflexia of both inferior limbs. The Babinski’s sign was positive bilaterally; there was no loss of bladder control. The patient underwent a dorsal left hemilaminectomy (T10–T11) and partial laminectomy (T12). He was discharged seven days after the surgical operation with full functional recovery. Spinal epidural haematoma, first described by Blauby in 1808, is a rare condition with an incidence of 0.1/100 000/year [2]. It has been reported in all age groups but the incidence is higher after the fourth or fifth decade, rare in children, and has a male/female ratio of 1.4:1. It may be due to trauma, surgery, epidural catheterisation, coagulopathies, thrombolysis and anticoagulation therapy [3]. In approximately 50% of cases, no specific aetiology is identified, and the haematoma is labelled spontaneous [4, 5]. With the exception of cases characterised by an occult arteriovenous malformation, the bleeding originates from the venous system because the lack of valves in the epidural venous plexus makes this area vulnerable to any intrinsic change in pressure [6]. The diagnosis is difficult because the clinical presentation is often not specific: the first symptom is usually severe pain, and it can either be localised to the level

$Research paper thumbnail of Polymyalgia rheumatica and vertebral fractures: a 1-year pilot controlled study$

No data exist about the possibility that vertebral fracture in PMR patients could be independent ... more No data exist about the possibility that vertebral fracture in PMR patients could be independent of steroid therapy. For this reason, we aimed to investigate this topic by a case cohort study with a 1-year follow-up for each patient. We selected ten consecutive patients who experienced vertebral fractures (VF-group) during the Wrst month of 1-year follow-up period and without any other signiWcant associated condition. As a control group we studied ten control patients, without vertebral fractures and with a follow-up of 1 year, randomly selected among a larger group of patients aVected by polymyalgia rheumatica. The following data were analysed: eritrosedimention rate (ESR), visual analogical scale score (VAS), methyprednisolone daily dosage. Each patient had been monthly evaluated by the aforementioned clinical and laboratoristic parameters during the 1-year follow-up period. The VFgroup resulted with a higher and statistically signiWcant median corticosteroid 12-month total dosage [mean 3,480 mg (95%CI 2,805-3,030) vs. 2,760 mg (2,666.25-3,247.5)]. The VF-group had statistically signiWcant higher ESR and VAS AUC when compared to control group (median ESR AUC, 484.75 vs. 288.25; P = 0.0001; median VAS AUC, 70.75 vs. 43.5 P < 0.0001); ESR at the baseline (cut-oV >80 mm) showed a speciWcity of 90% (95%CI 56-100) and sensitivity of 70% (95%CI 35-93). VAS diVerence from Wrst to second month (cut-oV •3) showed a speciWcity of 90% (95%CI 56-100) and sensitivity of 80% (95% CI 44-97). Our results point out that vertebral fracture might be predicted from commonly used laboratory (ESR) and clinical (VAS) Wndings.