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Biomedical subjects

A Di Filippo

Publications and source records attributed to A Di Filippo.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Duodenal ulcer and Helicobacter pylori].

BACKGROUND: The purpose of this study was to evaluate the relationship between duodenal ulcer (DU), Helicobacter pylori (Hp) infection and genetic and enviromental factors, and its influence on treatment and long-term RESULTS. METHOD: In the course of an epidemiological study on the prevalence of esophagogastroduodenal diseases, 1,169 volunteers underwent an endoscopy of the upper part of the gastrointestinal tract. The relationship of incidence rate and size of duodenal ulcers and several risks factors was investigated. RESULTS: A DU was observed in 240 subjects (20.5%), mostly of male gender (64.4% - p<0.0001). The Histological presence of a gastric Hp infection was confirmed in 179 cases (74.6%); it did not influenced the mean size of the ulcers and the presence of gastric intestinal metaplasia, compared to subjects without Hp infection. However, a superficial chronic gastritis was observed in 95.9% of Hp+ subjects and in 83.3% of Hp- (p<0.003), whereas a familiar history of DU was noted in 33.3% of Hp+ subjects and in 50.8% of Hp- (p<0.02). The main risk factor for DU was represented by Hp infection in 119 cases (49.6%), by infective and genetic factors in 60 cases (25%) and only by the genetic factor in 31 cases (12.9%), and was not detected in 30 cases (12.5%). Ulcer recurrence rates, after medical therapy, were 0,5% and 6.5% (p<0.03) at a 2-month follow-up, and 2.2% and 49.1% (p<0.00001) at a 12-month follow-up, among Hp+ and Hp- patients, respectively. CONCLUSIONS: The most common risk factor for DU was a gastric Hp infection, alone or associated to the genetic factor. Since the high incidence of recurrences at a 12-month follow-up, patients affected with a DU but Hp- represented an important therapeutic concern.

Adolescent↗
PubMed2001

[Sevoflurane in stop-flow interventions. Hemodynamics study].

BACKGROUND: The so called stop-flow operation is based on locoregional perfusion with an antiblastic hypoxic solution of the region invaded by malignant tissue. Cardiocirculatory complications are common, mainly consisting of reduction of cardiac index, increase of arterial pulmonary pressure, systemic vascular resistance and heart rate. Sevoflurane has been used for its stable hemodynamic profile to reduce cardiocirculatory troubles. METHODS: Six patients were submitted to stop-flow operation. General anaesthesia was performed with Sevoflurane 1 MAC in Air/O2. The following parameters were recorded: nitroglycerin infusion m order to maintain the position of the balloon of the catheters, arterial oxygen saturation, end-tidal carbon dioxide, mean arterial pressure, central venous pressure, arterial pulmonary pressure, heart rate and mixed oxygen venous saturation; recordings were performed before stop-flow (T1), during stop-flow (T2) and 10' after reperfusion (T3). RESULTS: Before stop-flow (T1) all the parameters were normal. At T2 heart rate, cardiac index and pulmonary capillary wedge pressure increased whilst mean arterial pressure, systemic vascular resistance and pulmonary vascular resistance decreased. Ten minutes after the end of perfusion (T3) absence of variations in systemic vascular resistance, in pulmonary vascular resistance, in pulmonary capillary wedge pressure, in cardiac index and in mixed oxygen venous saturation were noticed. Heart rate and central venous pressure showed a tendency to decrease. CONCLUSIONS: The hemodynamic profile during stop-flow appears to be stable with general anaesthesia with Sevoflurane.

Aged↗
PubMed2000

Contrast-enhanced color Doppler US in malignant portal vein thrombosis.

PURPOSE: To assess the role of contrast-enhanced color Doppler US in the differential diagnosis of benign and malignant portal vein thrombosis. MATERIAL AND METHODS: Fifty-six patients with portal vein thrombosis underwent color and power Doppler US examination before and after i.v. injection of galactose-palmitic acid suspension. The criterion for diagnosing the presence and extension of thrombosis was the lack of visualization of portal vein flow in a segment of the portal vein. The criterion for diagnosing malignant portal vein thrombosis was the detection of pulsatile arterial flow, either hepatopetal or hepatofugal, in the thrombus. The US data were correlated with the types of portal vein thrombosis. RESULTS: Among the 56 patients, there were 40 benign and 16 malignant portal thromboses. Unenhanced Doppler US detected continuous blood flow in 24 benign thromboses and pulsatile in 3 malignant thromboses. No flow, either continuous or pulsatile, was detected in 16 cases with benign thrombosis and in 13 cases with malignant thrombosis. Contrast-enhanced Doppler US allowed to assess pulsatile flow in 15 cases with malignant thrombosis (94%). The use of pulsatile flow as diagnostic criterion of malignant thrombosis yielded a sensitivity of 57% and a specificity of 95% with conventional Doppler US, whereas contrast-enhanced US achieved a sensitivity of 94% and a specificity of 100%. CONCLUSION: Contrast-enhanced Doppler US is a reliable diagnostic tool for assessing malignant portal vein thrombosis.

Aged↗
PubMed2000

[Reflux oesophagitis and risk factors. Results of a population study].

BACKGROUND: To evaluate the prevalence and endoscopic grade of reflux oesophagitis (RO) and to correlate them to symptoms and to a list of risk factors including age, sex, weight, smoking, alcohol, work, hiatus hernia. METHODS: This study was carried out in Roccacorga (LT), a little town of 3435 inhabitants in central Italy. The sample totalled 1084 volunteers, aged over 18 years old and enlisted in opened cohort. After filling in the questionnaire, all the patients were subjected to esophagogastroduodenoscopy without eating for at least six hours and diazepam pretreated (10 mg ev). Three biopsies were routine performed on the 3 biopsies on distal esophagous wall. The RO range was evaluated according to the Savary-Miller classification. RESULTS: The RO was found in 443 patients (188 M, 42%; 255 F, 58%) (p<0.0002), a large number of asymptomatic patients (39%). The prevalence of hiatus hernia was 7.2%, RO associated in 60.3% (p<0005). The prevalence of associated gastroduodenal injuries was pointed out (p<0.03). Patients affected only by RO were mostly female (p<0.02). Precancerous esophagous were 0,37%. CONCLUSIONS: According to this study the RO diagnosed through endoscopy is much more prevalent than supposed, especially among females and it affects a younger age than reported (31-50 years). Smoking and alcohol are among male risk factors, while, in female, agricultural works, weight and hormonal state could have a leading role (p=NS).

English Abstract↗
PubMed1999

Glomerular permeability and trauma: a correlation between microalbuminuria and Injury Severity Score.

OBJECTIVE: To determine if there is a correlation between an increase in glomerular permeability, the magnitude of trauma, and the severity of illness. DESIGN: Prospective study. SETTING: Two university hospital intensive care units. PATIENTS: Forty consecutive critically ill trauma patients admitted directly to the intensive care unit within 120 mins of their injuries. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For each patient, urine was collected from the time of admission until 7 am the next day. Within 48 hrs, only one sample of all urine collected (5 mL) was examined for microalbuminuria and urinary creatinine. Results were expressed as the microalbuminuria/urinary creatinine ratio (MACR). The mortality rate in the intensive care unit, Injury Severity Score at the moment of admission, Acute Physiology and Chronic Health Evaluation III score, and Simplified Acute Physiology Score in the first 24 hrs were calculated for each patient. The data were analyzed using the Pearson test for linear regression and Student's t-test. During the first 24 hrs after trauma, there was an increase of MACR (6.9 +/- 0.6 mg/mmol) above normal (reference range, <3 mg/mmol) that was positively correlated with Injury Severity Score (31.4 +/- 1.9; r2 = .73, p < .05). However, there was no correlation between MACR, Acute Physiology and Chronic Health Evaluation III score, Simplified Acute Physiology Score, and mortality rate. CONCLUSIONS: Patients with trauma show an increase in glomerular permeability during the first 24 hrs after injury. The magnitude of this increase is correlated with the extent of trauma but does not seem significant enough to be predictive of severity of illness and/or outcome.

APACHE↗
PubMed1999

[Endonasal mupirocin in the prevention of nosocomial pneumonia].

BACKGROUND: To evaluate efficacy of mupirocin ointment nasal application in prevention of MRSA ventilatory associated pneumonia (VAP). METHODS DESIGN: prospective, double-blind, randomized, clinical trial. PATIENTS: 48 consecutive intubated patients admitted in the Intensive Care Unit during a three month period. SETTING: University of Florence; Intensive Care. INTERVENTIONS: Randomized application of 2 ml of Mupirocin ointment three times a day for three days (Group A; n = 24) or placebo (Group B n = 24). STATISTIC: Chi 2 or Fisher exact test. MEASUREMENTS: Bacteriologic evaluation of nasal carriage at admission in ICU, and after 3 days of prevention; evaluation of bacteriology of bronchial aspirate in the case of symptoms of ventilatory associated pneumonia. RESULTS AND CONCLUSIONS: Relative risk of nasal carriage by pathological bacterial strains is 7.2 times in hospitalized patients more than in home patients (18/25 vs 7/23); MRSA nasal carriage is present at admission on 20% of hospitalized patients. Nasal carriage of Staphylococcus strains is reduced of 90% by Mupirocin application but is reduced only of 50% by placebo application (p < 0.05). In Group B, VAP occurred in 5 patients vs 3 of Group A; the more frequent incidence of VAP in group B is due to MRSA infection (p < 0.01) and it is related to MRSA nasal carriage.

Administration, Intranasal↗
PubMed1999

[Correlations between molecular biology of sepsis and of other primordial stressors].

The molecular response to endotoxins includes the molecular responses to light, oxygen and heat which may be regarded as parts of a single ancestral stress. Laboratory data suggest that a) light stress provokes molecular responses that are also caused by oxidative stress and endotoxins; b) heat stress activates heat shock proteins, as do oxidative stress and endotoxins; the former protect against oxidative stress, heat stress and endotoxins; c) oxidative stress activates antioxidant enzymes like endotoxin; these protect against endotoxins; d) endotoxin-related stress activates the molecular responses to all the aforesaid primordial stresses. Many laboratory findings prompt us to conclude that the molecular response to endotoxemia and sepsis is an archetypal response common to all forms of primordial stress.

Cytokines↗
PubMed1997

[Accident during retinal fluorescein angiography].

OBJECTIVE: To evaluate adverse reactions frequency following fluorescein i.v. administration to perform retinoic angiography (ARF). DESIGN: Retrospective study. SETTING: Eye Clinic of the University of Florence. MATERIALS AND METHODS: 6524 patients undergoing 10,003 ARF. PARAMETERS EVALUATED: For each patient age, sex, concomitant diseases, previous ARF, allergic history and any adverse reaction were evaluated. RESULTS: Adverse experiences were described in 7.5% of 6524 patients. Most of the observed reactions were mild: nausea (3.8%), vomiting (0.43%), vasovagal phenomena (1.18%), anaphylactoid reactions (1.84%). A major rate of adverse reactions were observed in patients previously submitted to ARF who reported in the anamnesis a previous adverse reaction, and in those with a positive allergic history. Severe reactions occurred in 0.27% of patients, but only in 2 of 6524 patients a rianimatory treatment (0.03) was necessary. CONCLUSION: From the data retrospective analysis it was observed that the manifestation of mild adverse effects was to be expected in many cases. It was therefore possible to point out classes of patients at risk (patients who reported a previous adverse reaction after ARF and patients with positive allergic history). Unfortunately it was not possible to expect and so to prevent the severe effects. Thus it is recommended to perform ARF in an adequately equipped room.

Adolescent↗
PubMed1995

[High-dose vecuronium in "open-eye" emergency surgery].

BACKGROUND: Succinylcholine is contraindicated in "open eye" surgery because it raises intraocular pressure. High dose vecuronium reduces onset time for orothracheal intubation. The objective of the study was to evaluate clinical efficacy of high dose vecuronium (0.2 and 0.3 mg/kg) and its effects on intraocular pressure for its use in "open eye" emergency surgery. DESIGN: Randomized, prospective, clinical trial. SETTING: Eye clinic of University of Florence. PATIENTS: 40 patients scheduled for vitrectomy, excluding any drug action on IOP, subdivided into two groups: the first (20 patients) had 0.2 mg/kg vecuronium at the induction of anaesthesia, the second (20 patients) 0.3 mg/kg. ANAESTHESIA: Premedication: atropine 0.01 mg/kg. Preinduction: fentanyl 3 micrograms/kg. Induction: thiopentone 4 mg/kg+ after 1 minute) vecuronium. Orotracheal intubation after 90". MEASURES: IOP was obtained by applanation tonometry in three time: T0 = preinduction; T1 = 50" after thiopentone; T2 = 50" after vecuronium. Systodiatolic pressure was obtained at the same time. Neuromuscular function was evaluated by vocals cord relaxation and by clinical evaluation of response to ulnar nerve stimulation (by train of four). STATISTIC: "t"-Student. MAIN RESULTS AND CONCLUSIONS: No modification of IOP and systodiastolic pressure was caused by administration of vecuronium; no statistic differences are between T1 and T2 values. All patients were intubated after 90" vecuronium administration; the vocal cord relaxation was maxima in all the patients. High dose vecuronium seems to be useful in "open eye" emergency surgery when succinylcholine is contraindicated.

Adult↗
PubMed1995

[Variations of esophageal temperature during general anesthesia with a low-flow circuit].

BACKGROUND: Anaesthesia drugs cause the cutaneous vasodilatation that produces core temperature lowering at the beginning of general anaesthesia; when the thermal threshold for vasoconstriction is reached the cutaneous heat losses are decreased. Furthermore, the soda lime begins to produce water and heat after 40 minutes of closed circuit ventilation. WORK HYPOTHESIS: The technique of inhalatory anaesthesia affects the thermal loss of patients after some hours of ventilation. DESIGN: Prospective randomized clinical trial. SETTING: Surgical Clinical operating theatre of the University of Florence. PATIENTS: 50 patients submited to abdominal non vascular surgery, for longer than 2 hours, with xifo-pubic cut, subdivided into two groups with the same anthropometric characters and age; the first ventilated with open system, the second with low flow circuit (fresh gas flow 700 ml/min). STATISTIC: "t" Student test; MEASURES: Lower one third oesophageal and inspiratory jaw of the circuit temperatures recorded for three hours. MAIN RESULTS: The savings of low flow anaesthesia begin to be significant in the third hour of anaesthesia. CONCLUSIONS: The thermal saving of closed circuit anaesthesia is, very probably, related to the humidifying and the warming of inspired air by soda lime reaction; the effect is more evident if cutaneous losses are reduced.

Anesthesia, General↗
PubMed1995

[Vecuronium for anesthesia in developing countries].

BACKGROUND: Some authors affirm that vecuronium efficacy is modified by anthropometric characteristics of people. However this drug is useful in several clinical conditions, it has very few collateral effects and it is easily stored and carried. AIM OF THE WORK: To evaluate the difference in efficacy of vecuronium in Brasilian and Italian patients. PATIENTS AND SETTING: 48 patients (21 children) submitted to ophthalmological surgical procedures in San Francisco Hospital of Grajaù (Maranhao, Brazil) and in Eye Clinic of University of Florence. STATISTIC: Student "t" and chi 2 tests. MEASURES: Myorelaxation was evaluated by a clinical score of intubation, clinical evaluation of TOF response after induction of anesthesia, recovery time after decurarization. MAIN RESULTS AND CONCLUSIONS: The two adult people (Brazilian and Italian) had significantly different weight. Children had different age/weight correlation. No significant differences exist in myorelaxation evaluation. Our results don't confirm the vecuronium efficacy differences in anthropometrically different people.

Adolescent↗
PubMed1994

[Evaluation of an experimental model of multiple organ dysfunction].

OBJECTIVE: To perform an experimental model of Multiple Organ Dysfunction Syndrome (MODS) without employing bacteria or endotoxin stimulus and to follow its evolution in vivo by a Computerized Tomography analysis of the lungs. DESIGN: Rats were submitted to intraperitoneal injection of a 2.5% zymosan suspension in mineral oil (1 g/kg weight) or mineral oil alone; control rats received no treatment. METHODS: The observation period was 15 days. During this period symptoms and survival were noticed daily. CT scans of lungs were made at the 7th and 14th days; data were post-processed to obtain information on lung density. The rats were sacrificed at the 15th day by heart puncture; blood was utilized for determination of hemochrome, differential leukocyte count, thrombocytes, glycemia, uremia, bilirubin. Lungs, liver, spleen and kidney were dissected and weighted for determination of relative organ weight. DATA ANALYSIS: Data were compared by "t" Student's test for impaired data and Fisher Exact test. RESULTS: Symptoms, survival, blood analysis and relative organ weight agreed with a progressive, ingravescent, triphasic illness caused by a systemic inflammatory response involving remote organ too. The CT study proved able to monitoring and analyzing organ damage: a temporal sequence of evolution of damage exists; organ damage is localized in microcirculatory system (density augment) and in parenchyma (morphologic alterations and fibrosis). DISCUSSION: The described experimental model reproduces a MODS-like illness in zymosan receiving rats; the CT scan is effective to evaluate the evolution of organ damage.

Animals↗
PubMed1993

[Respiratory mechanics and gas exchange in anesthesia for laparoscopic cholecystectomy].

OBJECTIVE: To evaluate the influence of endoabdominal CO2 insufflation during anaesthesia for laparoscopic cholecystectomy on airway pressure, gas exchange and their relationships. DESIGN: Perspective; clinical investigation. SETTING: Operating room at a central general hospital. PATIENTS: 14 patients (3 males and 11 females) ASA 1-2, non smokers, without lung disease, scheduled for elective laparoscopic cholecystectomy. INTERVENTIONS: During balanced anaesthesia (N2O/O2, Fentanyl, Isoflurane), with fixed minute ventilation, endoperitoneal insufflation of CO2 held at constant pressure (21 cm H2O). MEASUREMENTS: Serial measurements of: Airway pressure, near-static compliance, ETCO2, CO2 minute production, blood gas analysis and derived data: P(a-A)O2, P(a-ET)CO2, Vd/Vt. MAIN RESULTS: During insufflation peak and pause pressures increased by 6 cm H2O and mean pressure; by 3 cm H2O; Compliance was reduced by 48%; PaO2 decreased evenly with time (p > 0.05) irrespective of the airway pressure. PaCO2, PECO2, VCO2 and Vd/Vt after a sharp increase stabilized at 30% (mean value) over the baseline. P(a-ET)CO2 and Vd/Vt fluctuate in the physiological range except for two short but significant changes (p > 0.05) at insufflation and desufflation time. CONCLUSIONS: Laparoscopic technique for cholecystectomy, at least in healthy patients, produces relevant changes in airway pressures but only minor modifications of gas exchange, similar to those seen during general anaesthesia. This technique can be safely used for routine operation with standard monitoring equipment.

Adult↗
PubMed1993

[The clinical evaluation and immunological response of a new measles vaccine].

For a number of years the measles vaccine has been tabled to be included among the compulsory vaccines with the not impossible aim of wiping out this disease. In practice, however, there have been isolated attempts to impose mass vaccination but, given that it is not compulsory, there has been a certain degree of resistance to the vaccine. In an attempt to interpret the reasons for this resistance we have identified three main causes: cultural heritage by family doctors and sometimes pediatricians ("a disease which is important to have had"). Limited information with underestimation of damaging effects of disease overemphasis of side-effects of vaccine and, among these, in particular fever which 30-35% of vaccinated children present between day 8-10, and the possible allergic reaction (chicken embryos-antibiotics). Using the latter as a starting point, we assessed the efficacy and tolerability of the Moraten Berna vaccine on 165 children aged between 10 months and 8 years. This vaccine is prepared using the Edmonston Zagreb strain cultured in diploid human cells, and does not therefore contain heterologous proteins, seroconversion was assessed in 54 of the vaccinated children (aged 10 months--3 years) by blood sample collected following an interval of between 40 and 120 days after vaccination. Anti-measles antibody titering was assayed using a neutralisation test on plates of cellular monostrate by assessing the titer (starting dilution of serum in test: 1:8). Seroconversion, as shown in table I, was obtained for all vaccinated subjects who presented a mean antibody titer of 916 mUI/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Viral↗
PubMed1993

[Combined anesthesia (epidural-general) in thoracic surgery: the cardiocirculatory response to induction. Propofol vs midazolam plus alfentanil].

Thoracic epidural block may unpredictably blunt the physiological sympathetic response to anaesthetic agents and profound hypotension could result at induction time. The authors evaluate two different induction regimens in 16 patients scheduled for major thoracic surgery in order to assess which of them would produce less hemodynamic changes. After the institution of high thoracic epidural block (6 ml lidocaine-CO2 2% + epinephrine 1/200,000 level: th.2-3), patients were randomly allocated in two induction groups: P and M. Group P received 2 mg/kg of propofol over 30 seconds; group M received midazolam 0.2 mg/kg plus alfentanil 30 mcg/kg. In Both groups induction was followed by a significant drop in blood pressure (-18% in group M and -37% i group P. In P group the fall in blood pressure is more pronounced than M group (p < 0.05). Noteworthy in both groups cardiac frequency do not increase and in M group significantly lowers. In the authors view the midazolam plus alfentanil induction technique compare well with propofol alone and would recommend its use in poor risk patients.

Adult↗
PubMed1992

[Alfentanyl and midazolam in combined anesthesia. Clinical evaluation].

We have evaluated the effectiveness of a technique of blended anaesthesia (epidural-general) in 31 patients undergoing major surgery. Thoracic epidural blockade with lidocaina CO2, adrenalin 1/200000, ensures analgesia while induction and hypnosis maintenance were obtained with midazolam, alfentanil, atracurium and N2O/O2. This technique seems able to protect the patients from endotracheal intubation and surgical stress and also to enable a rapid, quiet awakening. The dose of midazolam necessary to maintain hypnosis was inversely proportional to the patient's age. The reversal of hypnosis was necessary in 4 patients only.

Adult↗