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Biomedical subjects

B Andreoni

Publications and source records attributed to B Andreoni.

54 records · Page 3Linked to original sources
PubMed1991

[Abdominal trauma].

Explore the source record for details and available documents.

Abdominal Injuries↗
PubMed1989

Role of hepatic histologic findings in the prognosis and treatment of bleeding esophageal varices.

In the period from 1976 to 1986, we performed 329 hepatic needle biopsies using a posterior extraperitoneal approach in patients with bleeding esophageal varices. The histologic findings subdivided according to a four-stage classification were correlated significantly with immediate survival. Specifically, 21 of 23 stage IV patients with severe degenerative and necrotic parenchymal lesions died after immediate emergency surgery, whereas 26 of 48 stage IV patients who did not undergo emergency surgery survived. Stage IV patients appeared unable to withstand major surgery. According to our data, histologic stage and Child's class are independent parameters, especially in emergency situations, since they quantify different aspects of functional liver failure. Therapeutic implications are presented based on cumulative analysis of histologic stages and Child's classes.

Biopsy, Needle↗
PubMed1989

Percutaneous ultrasonic lithotripsy of intrahepatic gallstones under endoscopic control.

Percutaneous ultrasonic lithotripsy in association with endoscopic control and balloon catheter dilatation of stenosed cholangiojejunostomy was successfully used in the treatment of a 53-year-old man with intrahepatic gallstones and severe cholestasis. Previously, he had undergone several biliary surgery operations, but all interventions were complicated by stenosis. The good results obtained in this case lead us to consider percutaneous ultrasonic lithotripsy a possible alternative to surgical treatment of complicated gallstones.

Adult↗
PubMed1988

Effects of somatostatin on acute pancreatitis induced in rats by injection of taurocholate and trypsin into a temporarily closed duodenal loop.

The effect of somatostatin on the course and severity of experimental pancreatitis was tested. Acute pancreatitis was induced in 210 Sprague-Dawley rats by injecting a 4.3% sodium taurocholate solution, saturated with trypsin, into a temporarily closed duodenal loop. Immediately after the end of the surgical procedure somatostatin or, alternatively, normal saline were administered as a bolus followed by continuous subcutaneous infusion for 9 h. Ninety rats (30 untreated, 30 saline-treated and 30 somatostatin-treated) were sacrificed 10 h after the induction of pancreatitis to assess the histologic severity of pancreatic lesions, the amount of peritoneal exudate and the circulating levels of amylase. In another 120 rats (40 untreated, 40 saline-treated and 40 drug-treated) the mortality rate was evaluated so that the histologic examination of the pancreas followed spontaneous death. In sacrificed animals somatostatin treatment lowered serum amylase levels and definitely improved pancreatic histopathology (edema, leucocyte infiltration and necrosis). The drug prevented the occurrence of severe necrosis in all treated animals. Somatostatin did not affect the mortality rate of pancreatitic rats (70%) although post-mortem histologic examination revealed significantly less pancreatic histopathology in drug-treated rats than in their controls.

Acute Disease↗
PubMed1985

[Hepatic biopsy by posterior extraperitoneal puncture. Statistics of 1000 cases].

The authors report an analysis of 1000 hepatic biopsies performed with an original method with posterior extraperitoneal approach. This method let the biopsy execution also in the patients in which the hepatic biopsy with lateral approach was contraindicated (31%). An adequate sample for histologic examination was obtained in 98,3% of cases. An important element of safe is now considered the ultrasound guide. The incidence of greater complications has been modest (7 arterious-venous fistulas, 1 retroperitoneal hematoma, 1 cardiac arrest by probable vagal inhibitory reflex).

Arteriovenous Fistula↗
PubMed1981

[Early diagnosis of stomach cancer: report on 23 cases including 15 patients with an acute hemorrhage or perforation (author's transl)].

Early gastric cancer was detected in 23 patients, 15 of whom had acute complications of either hemorrhage or perforation. Cases with acute complications often have a more favorable prognosis as a carcinoma may be identified while still in its pre-invasive stage. The gravity of the complication should not result in the employ of limited diagnostic procedures (e.g. endoscopy without multiple biopsies) or the use of incomplete therapeutic measures (e.g. simple suture of a perforated ulcer). The treatment of hemorrhagic gastric ulcers and perforated ulcers is discussed in greater detail. The need for a continuous follow-up of these patients with gastric ulcers is emphasized. This should include periodic endoscopy examination and multiple biopsies, even when a gastric ulcer has been apparently cured by medical treatment.

Adult↗
PubMed1979

The role of cardiovascular hemodynamics and liver histology in evaluating bleeding cirrhotic patients.

Preoperative cardiovascular hemodynamics and percutaneous liver biopsies were used to evaluate the pathophysiologic factors determining the operative prognosis of patients with cirrhotic liver disease and bleeding esophageal varices. These studies confirm the observations of Siegel that the greater the magnitude of the peripheral abnormalities in vascular tone and oxygen consumption the better must be the capability of the ventricular function, if the cirrhotic is to survive emergency or urgent portal decompressive surgery. These studies also show that the cardiovascular hemodynamics are directly correllated with the nature and degree of the abnormalities in the liver biopsy, and that pathologic and physiologic features of this disease which impact on surgical prognosis can be expressed through the easily obtained Survival Index. Bleeding cirrhotic patients with poor quality hemodynamics and poor histologic characteristics should be treated non operatively, since the operative mortality appears greater than that produced by a strategy of medical supportive therapy and delayed surgery if stabilization occurs.

Biopsy, Needle↗
PubMedDate not supplied

Glucose-clamp by artificial pancreas in the study and management of a patient with insulinoma.

Four euglycemic glucose-clamp studies by artificial pancreas (Biostator, Miles) have been performed during prolonged fast before and after pharmacological treatment in a patient with insulinoma. In the basal state a high glucose infusion rate (8.9 g/h) was unable to achieve the preselected blood glucose plateau of 80 mg/100 ml. The plasma insulin levels during this first glucose-clamp were comprised between 18 and 50 microunits/ml. On the first day of diazoxide treatment (300 mg/die),. the glucose infusion rate decreased to 6.4 g/h, without variation in plasma insulin level, thus suggesting a diazoxide effect independent of the inhibition of insulin secretion. After 7 days of diazoxide treatment, a further reduction of glucose infusion (5.8 g/h), together with a lowering of plasma insulin levels (7-18 microunits/ml) was observed. Both in the basal state and during diazoxide treatment a circadian pattern of glucose requirement was noted, with lower glucose need and plasma insulin levels during the night. Surgery was undertaken with glucose-clamp by artificial pancreas; blood glucose level being higher than the preselected value of 80 mg/100 ml, simple monitoring of glycemia was performed. The excision of a single adenoma was followed by a substantial rise in blood glucose 20 min later. An additional glucose-clamp, performed 3 months after surgery showed a dramatic fall of the glucose infusion rate (2.9 g/h) needed to achieve the preselected blood glucose plateau, confirming the completeness of the intervention. This experience shows that glucose-clamp by artificial pancreas may be of great value in the study as well as in the pharmacological and surgical treatment of patients with insulinoma.

Adenoma, Islet Cell↗
PubMedDate not supplied

Flexible sigmoidoscopy as a colorectal cancer screening test in the general population: recruitment phase results of a randomized controlled trial in Lombardia, Italy.

UNLABELLED: A two arm multicentre randomized controlled trial is in progress to evaluate the efficacy of flexible sigmoidoscopy (FS) as a screening test for colorectal cancer in the general population. AIMS: To determine the acceptance rate and feasibility of FS as a colorectal cancer screening test in average-risk asymptomatic volunteers. Average-risk, asymptomatic subjects, aged 55-64 years and assisted by 244 general practitioners (GPs) in Lombardy, Italy, were invited by postal questionnaire (PQ) to enter a study for the prevention of colorectal cancer and asked to indicate their interest in, and willingness to undergo, screening: those responding positively were randomized to the intervention or control arms. GPs were trained in colorectal cancer screening and proposed free FS to their patients randomized to the intervention arm. All sigmoidoscopies were performed by experienced endoscopists. Small polyps were removed at FS. Colonoscopy was indicated for high risk polyps (size more than 5 mm, more than two adenomas, villous histology, severe dysplasia or malignancy). 40,945 subjects were invited. 667 PQs were returned undelivered due to postal failure. 7,892 (19.59%) subjects responded, 2,116 of whom (26.81%) were not included, presenting 1 or more exclusion criteria. We randomized 5,778 volunteers and performed 1,582 sigmoidoscopies out of 2,885 subjects in the intervention arm (54.84% acceptance rate). Although the screening procedure had a good attendance rate in the intervention group, involvement of the people invited was lower than expected. Future FS screening programmes will require a keener focus on recruitment strategies, mainly with participation of GPs.

Colorectal Neoplasms↗
PubMedDate not supplied

Comparison of continuous versus intermittent hepatic pedicle clamping in an experimental model.

BACKGROUND/AIMS: The tolerance of the liver to ischemia obtained with intermittent clamping of the hepatic pedicle or continuous Pringle maneuver was tested. METHODOLOGY: Ninety rats were divided into three groups undergoing total duration of clamping ischemia of 60, 90, and 120 min. Each group of rats were subdivided to receive continuous Pringle maneuver, 30-min or 15-min intermittent clamping. The clamp release time between the periods of liver ischemia was 5 min. Survival at 7 days and postoperative changes of liver function (transaminase enzymes, bilirubin, and adenosine-5'-triphosphate levels (hepatocellular damage index) were recorded. RESULTS: Intermittent clamping of the hepatic pedicle was better tolerated than the continuous clamping method. With continuous clamping the rat survival rates inversely correlated with the duration of ischemia. Survival rates at 15-min and 30-min intermittent ischemia groups were significantly higher than in the continuous clamping group. CONCLUSIONS: This data suggest that when the Pringle maneuver is adopted, it should be applied intermittently rather than continuously.

Animals↗
PubMedDate not supplied

[Feasibility of exeresis. Controversial aspects in the surgery of carcinoma of the pancreas].

Pancreatic cancer has a dismal prognosis also after resection with a 5 years' survival of about 5% in operated patients. The main clinical issue in patients with a malignant tumour is to identify the ones that would benefit from a surgical treatment. Resectability of pancreatic cancer has not an absolute value and the possible advantages in terms of prognosis and quality of life should be balanced with surgical mortality and morbidity. For this reason the management of this disease involves a multidisciplinary approach and the surgeon should join with the other specialists in experienced oncology centers. En exhaustive evaluation of the following prognostic factors should be made pre and intra-operatively to better define life expectancy with or without resection: Histotype: endocrine tumours and cystadenocarcinoma have, in general, a better prognosis, Staging: JPS classification has a better prognostic value if compared to the UICC. Completeness of the resection. Biological characteristics of the tumour. The main variables to be considered for the exeresis are: Size and local growth of the tumour (also considering the involvement of vessels, retroperitoneum and pancreatic capsule). Liver or peritoneal metastases: for this laparoscopy has a key role for staging. Histologic confirmation: differential diagnosis with chronic pancreatitis is sometimes difficult and every attempt should be made to have a pre-operative histology. Vascular invasion is one of the main contraindications to surgery and an exhaustive evaluation of vascular involvement should be considered mandatory. Lymph nodal involvement, in general, represents a negative prognostic factor even if Japanese authors claim that a radical resection can be performed in case of positive nodes in the peripancreatic area, if a complete lymphadenectomy is carried out.

Carcinoma↗