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Biomedical subjects

C Franco

Publications and source records attributed to C Franco.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Homograft replacement of aortic valve and ascending aorta].

From May 1990 through December 1994, integral valved aortic homografts were implanted for replacement of the aortic valve and of part or the whole of the ascending aorta in 24 patients with a mean age of 45.5 years (17-66 years). Ten patients (41.7%) had infective endocarditis of the aortic valve (4 of the native valve and 6 prosthetic). Seven of these had root abscesses (70%), one with a fistula to the right atrium, resulting in a variable degree of discontinuity between the left ventricle and the aorta. Twelve patients (50%) had ascending aortic aneurysms and the remaining two (8.3%) had aortic dissection. Three patients (12.5%) also had mitral pathology, one had triple vessel coronary disease, one had aortic coarctation and another one had a sub-aortic membrane. Two thirds of the patients were in NYHA class III/IV and 10 (41.7%) had moderate or severe left ventricular dysfunction. A modified Bentall technique utilising fresh aortic homografts was used in all patients. The homografts were harvested aseptically from donors with a mean age of 30 years (16-54 years) and preserved at 4 degrees C for a period of 1-43 days (median-13 days). Six patients (25%) had associated surgery: mitral valve replacement; mitral valvuloplasty with a ring; closure of aortic- atrial fistula, resection of sub-aortic membrane; triple coronary artery bypass; and mitral and tricuspid annuloplasty and closure of ASD (one patient each). Postoperatively three patients (12.5%) required reexploration for excessive blood drainage in the first hours and one patient with complete A-V block required a pacemaker (4.2%). Hospital mortality was 4.2% (one patient). At the time of discharge, no patient had significant Doppler or echocardiographic aortic gradient or regurgitation. All patients were followed for a mean period of 31 months (7-62 months). One patient died of a non cardiac death and the remainder are in NYHA class I without thromboembolic or haemorrhagic accidents and with echocardiographic findings similar to those observed at discharge. These results suggest that aortic homografts constitute an effective and safe method of reestablishing the continuity between left ventricle and aorta, especially in the presence of an infective process with root abscesses.

Adolescent↗
PubMed1995

Using clinical signs to diagnose anaemia in African children.

Anaemia is a serious and common problem among young children in sub-Saharan Africa. As a first step towards developing guidelines for its recognition and treatment, we conducted a study to evaluate the ability of health workers to use clinical findings to identify children with anaemia. Health care workers examined a total of 1104 children under 5 years of age at two hospital-based outpatient clinics in rural Malawi. Blood samples were taken to determine haemoglobin concentrations. Pallor of the conjunctiva, tongue, palm or nail beds was 66% sensitive and 68% specific in distinguishing children with moderate a anaemia (haemoglobin concentration, 5-8 g/dl) and 93% sensitive and 57% specific in distinguishing those with severe anaemia (haemoglobin concentration, < 5 g/dl). Even without laboratory support, which is often unavailable in rural Africa, clinical findings can identify the majority of children with anaemia.

Anemia↗
PubMed1995

[Fine needle aspiration biopsy of thyroid nodules. Analysis of results obtained using a new method with histological examination of the sample].

Fine needle aspiration biopsy (FNAB) is the most useful preoperative work up method for patients with nodular goiter. We analyze 173 patients that underwent FNAB and were subsequently operated. The sample with FNAB was processed both for cytological and histological study, using methods developed at the hospital. The preoperative diagnosis reached was compared with that obtained with the surgical piece. Results showed that the histological analysis of the FNAB sample improved the sensitivity of the method, when compared with the cytological study, from 68.5% to 87.8% (p < 0.035) without modifying specificity (100% for both methods). It is concluded that FNAB with histological study of the sample has a high diagnostic yield and is exempt of complications.

Adolescent↗
PubMed1994

Epileptic seizures in intracerebral hemorrhage: a clinical and prognostic study of 55 cases.

Fifty-five cases of epileptic siezures associated with spontaneous intracerebral hemorrhage are reported. Seizures appeared as the first symptom in 23 patients, early (within two weeks after HI) in 18 and late (later than 2 weeks after HI) in 14. From the analysis of the observed cases we noticed that: 1) partial seizures were most frequent type (63%). These appeared mainly in cases with lobar hemorrhage above all; 2) development chronic epilepsy occurred frequently in the case of patients affected by late seizures. We compare our data with those reported in literature in order to highlight main factors which affect the onset and development of seizures associated with spontaneous intracerebral haemorrhage.

Adolescent↗
PubMed1994

[Papillary cystic tumor of the pancreas: an infrequent carcinoma of good prognosis].

Papillary cystic tumor of the pancreas is a rare low grade carcinoma, with only 130 cases reported in the English literature. We report a 22 years old female presenting with a palpable mass and abdominal pain. Abdominal ultrasound and CAT scan showed a solid-cystic lesion in the head of the pancreas. The patient was subjected to a partial pancreatoduodenectomy and the histological study of the surgical specimen disclosed a papillary cystic carcinoma. Post op course was uneventful and the patient is well at 8 months follow up.

Adult↗
PubMed1993

Plasma exchange in systemic lupus erythematosus. Experience in thirty-seven patients.

Thirty-seven (37) SLE patients submitted to therapeutic plasmapheresis were examined. The results were good in the active stage of the disease. Various types of antibody, anti-DNA, anti nucleus, anti-cardiolipine, I.C. (Clq and C3d) were removed. The values of IgG, coagulation factors, creatinine and proteinuria were assessed. Close collaboration with the clinicians is urged, with the aim of applying immunosuppressive therapy immediately after P.E. to consolidate the results obtained.

Adolescent↗
PubMed1993

[Effectiveness and tolerability of simvastatin in subjects with primary hypercholesterolemia. Multicenter study].

The efficacy and safety of simvastatin were evaluated in an open multicenter study over a 24-week period. One hundred seventy-two patients (91 men, 81 women) with primary hypercholesterolemia (mostly polygenic) were enrolled in 14 Centers in Northern Italy. The mean age was 55.8 +/- 9.7 years and the mean baseline total cholesterol level was 305 +/- 59 mg/dL. After 4 weeks on an AHA step 1 diet, patients who met the inclusion criterion (total cholesterol > or = 250 mg/dL) were given simvastatin 10 or 20 mg in the evening. The dose could be titrated up to a maximum of 40 mg o.d. at week 6 and 12. No dose titration was allowed after week 12. One hundred forty-nine patients (86.6%) completed the study according to the protocol, 2 (1.2%) were withdrawn from the study because of adverse events not related to the drug, 21 (12.2%) were unavailable for follow-up. Simvastatin treatment was associated with a sustained dose-related reduction in total and LDL cholesterol (-28% and -39% respectively at the end of the study). Triglycerides showed a significant descending trend (-16% at week 24) and HDL-C increased by 9%. Apolipoproteins were measured in only 25 patients: apo B was reduced by 30% and apo A1 increased by 9%. Clinical side effects were not relevant. Mean levels of GOT, GPT and CPK significantly increased after 6 weeks on simvastatin, but remained stable and at any rate ioitlin the normal range thereafter. Eight patients (5.4%) experienced small transaminase level elevations (< 3ULN) and six (4%) small CPK elevations.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Heart surgery without previous heart catheterization, in pediatric cardiology].

STUDY OBJECTIVE: To determine the influence of echocardiography in the preoperative diagnosis of heart diseases in children. DESIGN: Retrospective study. SETTING: Hospitalized children admitted in Departments of Pediatric Cardiology and Cardiothoracic Surgery. PATIENTS: Children of both sexes, aged from neonate to 14 years old, with heart disease who underwent cardiac surgery. MATERIAL AND METHODS: From January 1989 to July 1990, 220 consecutive cardiac surgeries were performed in children with heart disease. The initial diagnosis was based on data from clinical examination, electrocardiogram, thorax X-Ray and echocardiogram (M-mode, 2D, conventional and colour Doppler). Patients were separated in three groups according to their ages: newborn infants less than 28 days old; infants less than 12 months old; children more than 1 year old and less than 14 years old. Patients were separated according to the investigations used further for preoperative diagnosis: whether they had or not cardiac catheterization performed prior to surgery. RESULTS: From 220 surgical interventions performed, 124 were "open heart" surgeries (9 neonates, 28 infants and 87 children) and the remaining had "closed heart" operations (14 neonates, 37 infants and 45 children). Preoperative diagnosis was mainly dependent on echocardiography, dispensing catheterization in 90 cardiac interventions. The diagnosis was confirmed at surgery or at autopsy. There were 9 deaths, 3 of which occurred in patients not submitted to cardiac catheterization. CONCLUSIONS: Echocardiography is a reliable method for investigation and establishment of the preoperative diagnosis of heart diseases in children. Its use may further reduce the need for diagnostic catheterization in children, particularly in risk groups.

Adolescent↗
PubMed1991

Cefaclor in the treatment of infective exacerbations of chronic bronchitis in cigarette smokers.

There is a direct correlation between number of cigarettes smoked and the incidence of lower respiratory tract infection in humans. In studies with smokers suffering from exacerbations of chronic bronchitis, the most common bacterial pathogens found were Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus and Branhamella catarrhalis. Antibiotics should be effective against such possible pathogens. Cefaclor has demonstrated in vitro activity against all these pathogens. We designed the present study to evaluate the efficacy and safety of cefaclor in the treatment of acute exacerbations of chronic bronchitis in cigarette smokers. A total of 106 patients were enrolled in the study. H. influenzae was the most common bacterial species isolated in the sputum (in 23.6% of the total sample), followed by S. pneumoniae (18.9%), S. aureus (17.0%), K. pneumoniae (7.5%) and B. catarrhalis (5.7%), while mixed forms were present in 22.6% of cases and other pathogens in 4.7%. Cefaclor (500 mg) was given orally every 8h for 7 to 16 days (mean 10.73 +/- 2.11). Analysis of clinical response data indicates that 75.5% of patients were cured and 17.0% improved. This finding is important because it demonstrates that cefaclor's spectrum of activity encompasses all the most likely pathogens encountered in smokers. Because of its excellent response rate, cefaclor is of particular value in the treatment of lower respiratory tract infections in cigarette smokers.

Adult↗
PubMed1990

Rett's syndrome: a neurophysiological study.

Thirteen girls with Rett's syndrome were evaluated with wakefulness and sleep polygraphic records and EMG studies. The main EEG findings were paroxysmal activity during sleep, multifocal in younger and unifocal in older girls, and "pseudorhythmic flattening". In the opinion of the authors, the changes with age are related to evolution of the disease or maturational changes of CNS. The affectation of the peripheral nervous system was demonstrated in almost half the patients.

Age Factors↗
PubMed1990

[Primary cutaneous lymphoma: experience with 10 cases].

We report 10 patients with cutaneous lymphoma along with their clinical findings, staging, histopathologic characteristics by light microscopy, and results of anti-HTLV antibody screening. The immunotype was T cell in all. Three patients were diagnosed as having Lymphomatoid papulosis: one of them evolved to Mycosis fungoides, another showed progression to Immunoblastic lymphoma and a third remains as such. Two patients had a long standing Mycosis fungoides and, finally, 5 cases had peripheral T-cell lymphoma. Of the latter, 2 progressed rapidly to death.

Adult↗
PubMed1990

Effects of plasma exchange (PE) in primary biliary cirrhosis (PBC). A pilot study.

Six patients were studied to evaluate the efficacy and safety of plasma exchange (PE) in the treatment of primary biliary cirrhosis (PBC). All patients were affected by PBC at stage III-IV and presented symptoms refractory to pharmacologic therapy. Patients underwent PE for a mean period of 40 weeks (range 10-88). A mean of 33 liters (range 17-64) of plasma per patients was removed. Patients reported less fatigue (4/6), pruritus (5/5), nausea (3/3), Sjogren's syndrome (2/6), and painful neuropathy (2/3). A reduction of xanthomata was noted in one of the three affected patients. Definitive improvement was seen in the patient with Raynaud's phenomenon. A significant reduction was noted for serum cholesterol and gammaglobulins. ALT, AST, gamma-GT, alkaline phosphatase, bilirubin, prothrombin activity, AMA titers were not affected by PE. All patients suffered some mild adverse effects during PE. Two patients (IV stage) developed late edema and ascites after 34 and 44 weeks of treatment. We conclude that PE can be considered effective chronic treatment for advanced symptomatic PBC refractory to pharmacological therapy.

Aged↗
PubMed1989

Anaphylactoid reactions to protamine: an often lethal complication in insulin-dependent diabetic patients undergoing vascular surgery.

Protamine is used routinely at our institution during arterial surgery to reverse the anticoagulant effect of heparin. Adverse fatal reactions to protamine are generally believed to be rare. However, major anaphylactoid reactions occurred in 11 of the last 1150 patients receiving this drug at our institution. Nine of these reactions occurred in 325 insulin-dependent diabetic patients (incidence, 3%), whereas only two occurred in the 825 patients not receiving insulin (incidence, 0.2%) (p less than 0.001). Ten of these reactions occurred within 10 minutes of protamine administration (15 to 35 mg), whereas one reaction occurred immediately after administration of a 5 mg test dose of protamine. Systolic blood pressure fell below 60 mm Hg in all of the 11 patients, and three patients had to be resuscitated with closed-chest massage. Initial treatment with epinephrine and steroids was successful in seven cases. Four patients required further resuscitative measures, including closed-chest massage. However, one of the patients died as a result of ventricular fibrillation resistant to treatment. Ten of the 11 patients, including the patient who died, had significant preexisting cardiac disease; six of the surviving 10 patients (60%) had perioperative myocardial infarctions and three died. Thus the total mortality rate was 36% (4/11). These data support the implication that neutral protamine Hagedorn (NPH) insulin produces an adverse reaction through immunologic presensitization of the patient. These data also show that, in the older vascular surgery population with a high incidence of significant cardiac disease, protamine reactions can be potentially lethal. Thus routine use of protamine should be avoided in diabetic patients receiving insulin.

Aged↗
PubMed1987

Natural killer cells in children with acute leukemia. The effect of interleukin-2.

The purpose of this study was to determine (1) the number and activity of natural killer (NK) cells in children with acute leukemia at different stages of their disease; and (2) the effect of interleukin-2 (IL-2) in enhancing NK activity of these patients' cells. The mean percentage of Leu 11+ NK cells in patients at diagnosis (5% of peripheral blood (PB) mononuclear cells) was significantly lower than for patients on maintenance (23%), post-treatment (21%) and for normal children (20%). The mean PB NK cell cytotoxicity for patients at diagnosis (16% lysis versus K562) and during maintenance (20%) was significantly lower than for post-treatment (41%) and normal controls (40%). After NK cells were incubated for 5 days with IL-2, NK cells from 82% (36/44) of patients showed enhanced cytotoxicity toward K562 and several acute leukemia cell lines as well as toward autologous leukemic cells. Cytotoxicity toward autologous cells was very low (0% to 5%, 16 hour assay) before IL-2 stimulation, and significantly increased (23% to 69%) after stimulation, suggesting that IL-2 may be a useful agent for enhancing the antileukemic immune response.

Acute Disease↗