[Clinico-therapeutic considerations on arterial embolism of the legs].
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Biomedical subjects
Publications and source records attributed to A Ippoliti.
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Surgical repair of abdominal aortic aneurysm (AAA) is frequently associated with DIC. 15 patients affected by AAA were studied to evaluate the risk of consumption coagulopathy and the efficacy of daily low-dose calcium heparin prophylaxis. The coagulation parameters investigated showed a postoperative decrease of AT III activity levels and platelet count the other laboratory tests did not show any significant modifications. Low dose heparin was effective in preventing coagulation activity or thrombotic episodes. No thromboembolic complications were observed, except nonfatal myocardial infarction.
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The purpose of this study was to compare the endoscopic and histologic findings in gastric mucosa, the total bile acids in the gastric contents, and the gastric emptying of a solid food in symptomatic and asymptomatic patients after vagotomy and antrectomy. Eleven male patients with typical symptoms of alkaline reflux were compared to six asymptomatic patients. There were no significant differences between the groups in output or concentrations of bile acid in fasting gastric juices. Evidence for gastritis by endoscopic or histologic features was present in asymptomatic as well as symptomatic patients. Gastric emptying of radiolabeled liver was faster in the symptomatic group, but the difference was not significant. In conclusion, these tests do not distinguish between patients with symptoms of alkaline reflux and asymptomatic patients after vagotomy and antrectomy.
The CURE peptic ulcer clinic started in April 1974. Patients (mostly veterans) with documented ulcer disease were interviewed regularly and inpatient hospitalizations were reviewed for follow-up periods of up to 6 years. Data from 245 male ulcer patients, 190 with duodenal ulcer alone and 55 with both documented duodenal ulcer (DU) and gastric ulcer (GU), were analyzed to assess the natural history of ulcer disease and factors predicting the severity of its course. Eleven percent of clinic patients had a complication (bleeding requiring a transfusion, perforation, or obstruction) during follow-up. Complication rates were about 2.7% per year for those with no prior complication, and about 5% per year for those with a prior complication. No patient variables or ulcer markers were related to the likelihood of a complication. Patients with both DU and GU were similar to patients with DU alone on many background variables, but the combined ulcer group had a significantly higher frequency of blood group nonsecretors, increased incidence of cigarette smoking, and greater frequency of complications or ulcer hospitalization prior to entry into the study and during follow-up. These factors, together with our failure to find differences in aggressive factors (acid output and PGI), suggests that DU + GU represents a different disease entity marked by additional defects in mucosal defense.(ABSTRACT TRUNCATED AT 250 WORDS)
This study was designed to compare the rates of duodenal ulcer healing and recurrence after treatment with cimetidine or antacid. Patients with endoscopically documented duodenal ulcer received cimetidine, 1200 mg daily, or Mylanta II, 7 oz daily, in a randomized, double-blind trial. For the 69 patients in each group who completed the healing phase of the trial, endoscopic ulcer healing was almost identical. At 2, 4, and 6 wk, the cumulative percent healed on antacid was 33%, 64%, and 80%, and on cimetidine it was 25%, 62%, and 86%. The 114 patients with healed ulcer were observed on no therapy and underwent additional endoscopy to detect recurrences when symptomatic or at 3, 6, and 12 mo. There was no difference in the frequency of recurrences between treatments. At 3 and 6 mo, the cumulative percentages of patients with recurrence were 29% and 56% after antacid therapy and 36% and 55% after cimetidine therapy. Some patient variables were associated with delayed ulcer healing or ulcer recurrence. These included sex, pain frequency, smoking, disease duration, and acid secretion.
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The evaluation of structural and functional abnormalities of the esophagus by manometry (using perfused tubes) and cine-radiography were compared in 25 subjects with progressive systemic sclerosis (PSS). Motility by both procedures was definitely abnormal in 19 subjects and normal in 3. The remaining 3 subjects had abnormal motility on manometry, coupled with cine-esophagrams interpreted as normal. Many structural abnormalities not demonstrated by manometry were identified by cine-radiography. Therefore, the initial diagnostic examination of motility in PSS should be the cine-esophagram.
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Extracts were prepared from plasma of 12 subjects with normal serum gastrin concentration (less than 125 pg/ml), 5 normal subjects and 7 patients with duodenal ulcer and basal gastric acid hypersecretion (greater than 15 mEg/hr). Bioassays of plasma extracts were performed in anesthetized rats with perfused stomachs and acid out-puts were compared with those produced by normal saline and by 50 ng pentagastrin given in random order. Compared with saline, plasma extracts from 5 of 7 hypersecretor patients produced significant stimulation of acid secretion while none of the extracts from normal subjects produced acid stimulation. The stimulant identified in plasma from hypersecretor patients appears to be distinct from gastrin.
Metoclopramide tablets were compared with placebo in the treatment of gastrointestinal symptoms in 40 patients with diabetic gastroparesis. Results of a 3-wk double-blind study indicate that metoclopramide at a dosage of one 10-mg tablet four times daily reduced nausea, vomiting, fullness, and early satiety and improved meal tolerance better than placebo. Statistically significant differences were noted for nausea and postprandial fullness. Mean gastric emptying assessed by radionuclide scintigraphy was significantly improved in the metoclopramide-treated group when compared with their baseline result. Metoclopramide is an effective agent for improving the upper gastrointestinal motor function in diabetic patients with gastroparesis.
Seventy seven patients affected by postphlebitic syndrome (PPS) during acute inflammatory and/or obstructive complications were controlled. Thirty nine patients were treated with a new low molecular weight heparin (Fluxum), 16,000 I.U. AXa/day subcutaneously for 10 days and, subsequently, 8,000 I.U. AXa/day subcutaneously for up to 50 days. Thirty eight patients were treated with 20,000 I.U./day i.v. for 10 days of sodium heparin and, subsequently, with 12,500 I.U./day of calcium heparin by subcutaneous injection for up to 50 days. Clinical symptoms (pain, oedema, hyperemia, rashes, itching, dermatitis, ulceration) and instrumental patterns (Doppler) were recorded. Fluxum had an evident effect on the improvement of patient's clinical performance during acute complications of PPS.
Aneurysms of the sciatic artery are quite rare. In the literature fewer than 100 cases of gluteal aneurysms have been reported; most have arisen from the superior or inferior gluteal artery; only few cases were aneurysms of an anomalous persistent sciatic artery (6 cases diagnosed angiographically and treated). In our own experience, the overall incidence of this anomaly, in patients undergoing angiography is very low, in the order of 0.025%. In our case the iliac femoral axis showed hypoplasia and required an internal iliac-popliteal bypass. For the location and the propensity atherosclerotic involvement of the persistent sciatic artery, an aneurysm should be considered in all patients with a pulsatile posterior thigh mass, with or not symptoms of peripheral vascular disease.
Esophageal motility disturbances are common in diabetics in general and are most prevalent in these with peripheral neuropathy or autonomic neuropathy. The usual findings are a decrease in the amplitude of esophageal contractions in the smooth muscle portion of the body, frequent absence of primary peristalsis, simultaneous or repetitive body contractions, and a decrease in the velocity of peristalsis. Radiographically, this may be manifest as delayed esophageal emptying. These changes do not produce symptoms. Dysphagia and chest pain should be thoroughly evaluated and not ascribed to the diabetes. Candidiasis may be more common in diabetics.
The authors, after having described, a case of biliary ileus, analyse the principal pathogenetic aspects of the disease, and underline the diagnostic and therapeutic difficulties. They believe that the simple enterolithotomy represents, initially, the best therapy, in particular with patients in poor clinical conditions.
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