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Biomedical subjects

D Birolini

Publications and source records attributed to D Birolini.

At least 37 records · Page 2Linked to original sources
PubMed1989

Comparison of aztreonam plus clindamycin with tobramycin plus clindamycin in the treatment of intra-abdominal infections.

The activity of aztreonam (a beta-lactam antibiotic with specific activity against gram-negative bacteria) was evaluated and compared with that of tobramycin in hospitalized patients with severe intra-abdominal infections due to gram-negative pathogens, either alone or in association with other bacteria. Of a total study population of 156 patients, 76 were assigned to treatment with aztreonam + clindamycin, and the remaining 80 were treated with tobramycin + clindamycin. Patients underwent a variety of surgical procedures involving the peritoneal cavity. The final clinical evaluation revealed similar percentages of satisfactory results: 86.8% for the patients in the aztreonam-treated group and 86.2% for the tobramycin-treated patients. Among the patients who had a poor therapeutic result, gram-negative bacteria, either alone or associated with gram-positive pathogens, were considered responsible for 50% of the infections in the aztreonam group; the percentage increased to 82% among those treated with tobramycin. The incidence of side effects and laboratory alterations was not significant and was similar in both groups. The results of this study suggest that aztreonam may be an effective and safe drug for the treatment of bacterial infections due to gram-negative pathogens.

Abdomen↗
PubMed1988

The efficacy of loop colostomy for complete fecal diversion.

In an attempt to evaluate the real efficacy of loop colostomy for fecal diversion, the authors studied 62 patients previously colostomized under emergency conditions. Radiologic series of the abdomen were taken after 200 gm of barium meal. The results showed that the colostomy provided complete diversion of the radiologic contrast in 53 patients (85 percent) and incomplete diversion in nine patients (15 percent). Analysis of the results revealed that incomplete fecal diversion was: 1) observed as of the 86th postoperative day, with a significantly higher frequency following the 10th postoperative month, and 2) significantly correlated with either colostomy retraction or prolapse. The authors present a diagram showing a possible interaction of factors responsible for incomplete fecal diversion in loop colostomy and conclude that: 1) retraction is probably the basic contributing factor for colostomy failure; 2) the prolapse, once reduced, propitiates sinking of the stoma, facilitating colostomy failure; 3) the common assumption that loop colostomy eventually fails to provide complete fecal diversion is further supported; 4) loop colostomy assures, over its usual duration, a satisfactory defunctionalization of the colon; and 5) use of improved techniques of colostomy construction may prolong complete fecal diversion.

Abdominal Muscles↗
PubMed1985

The role of lung innervation in the hemodynamic response to hypertonic sodium chloride solutions in hemorrhagic shock.

The role of pulmonary innervation in the genesis of hemodynamic responses to hypertonic salt solutions was assessed in an animal model of total lung denervation by total division of the pulmonary hilum followed by reimplantation of the organ. This was performed in 10 mongrel dogs (weighing 12 to 20 kg) randomly assigned to two groups: group I (five dogs) was comprised of animals with catheters placed in the pulmonary artery of the denervated lung; group II (five dogs) was comprised of animals with catheters placed in the pulmonary artery of the intact lung; a control group (group III) (five dogs) was submitted to a sham thoracotomy with catheters inserted in either pulmonary artery. On the seventh postoperative day the mean arterial pressure (MAP) was monitored and severe hemorrhagic shock (MAP = 40 mm Hg) was produced in all animals. After 30 minutes of shock the shed blood was discarded and 5% of the shed volume (+/- 2 ml/kg) was infused through the pulmonary catheter in the form of a hypertonic NaCl solution (2400 mosm/L). MAP continued to be measured for the 30 minutes following the infusion period. A significant rise of MAP was uniformly observed in animals of groups II and III. In group I low elevations of MAP were observed during the infusion period, followed by a return to shock levels on discontinuation of the infusion. The results suggest that selective lung denervation abolished the beneficial cardiovascular effects of hypertonic NaCl infusion during resuscitation from severe hemorrhagic shock without affecting the plasma osmolality pattern.

Animals↗
PubMed1984

Endoscopic percutaneous gastrostomy without laparotomy.

Observation and manipulation through the endofiberscope, have resulted in a new method of establishing gastrostomy without laparotomy. Subsequent to experimental studies with dogs, the new method was employed to substitute nasogastric tube in patients. In this new procedure, endoscopic application permits the placing of stitches in close contact with the abdominal and gastric walls. The fact that no complications were observed in the patients submitted to operative treatment, is largely attributed to this type of suture. From the results obtained it would seem that this procedure can be routinely employed instead of gastrostomy with laparotomy, since it offers the advantage of being a simpler method and is more likely to be associated with a lower rate of complications.

Animals↗
PubMed1983

The effect of major trauma on the pathways of thyroid hormone metabolism.

In order to evaluate the effects of severe trauma on the levels of thyroxine (T4), 3,3',5-triiodothyronine (T3), and 3,3',5'-triiodothyronine (reverse-T3, r-T3), blood samples were collected from traumatized patients on the first post-trauma day. The plasma concentrations of T3 were significantly decreased (mean, 47.4 ng/dl); T4 levels were in the normal range (mean, 6.6 mcg/dl) and r-T3 levels were significantly elevated (mean, 80.8 ng/dl). The oxygen extraction by the muscular tissue was also determined in these patients and found to be elevated; however, no correlation could be established between the extraction ratios and the thyroid hormone levels. This deviation in the peripheral conversion of T4 into r-T3 with a decreased production of T3 also accompanies severe systemic illnesses and probably represents a form of T4 inactivation conditioned by the metabolic demands of the body. This alternate pathway of thyroid hormone metabolism is enhanced by elevated blood levels of catecholamines, glucose, or glucocorticoids as well as by decreased insulin plasma concentrations, all known to follow major trauma and other catabolic conditions.

Adult↗
PubMed1983

Injuries to the tracheobronchial tree in closed trauma.

Seven cases of injury to the tracheobronchial tree in closed trauma of the thorax, treated by the surgical emergency service of the Hospital das Clínicas, University of São Paulo School of Medicine, during the period 1980-2 are described and compared with previously published cases. The diagnosis of the seven cases presented in this series was clinically suspected and endoscopically confirmed within 24 hours of injury, all patients being immediately submitted to reconstructive surgery; and except for one who failed to respond to initial resuscitation and died during surgery all the patients had a satisfactory postoperative course. Many previously reported cases of tracheobronchial injury by contrast have taken more than a month to be diagnosed; but for the best results such injuries must be repaired immediately. Awareness of the possibility of tracheobronchial injury in cases of violent chest trauma is important for early diagnosis; emphysema, dyspnoea, and pneumothorax are not always present, and absence of radiological and clinical signs of tracheobronchial injury does not exclude such injury. Bronchoscopy is the most important investigation for clinical diagnosis. Once the diagnosis has been made thoracotomy is nearly always required. Throughout the surgical procedure expert cooperation between anaesthetist and surgeon is essential. After operation prevention of further damage to the trachea depends on careful respiratory management.

Adult↗
PubMed1983

Pulmonary embolism from gunshot missiles.

In patients having missile wounds, the most bizarre trajectories and lodgment sites have been reported. Entry of the missile into the blood stream and subsequent embolization is quite an uncommon event. Isolated reports published in the literature date back to the beginning of the century. This article was undertaken to present two instances of pulmonary embolism due to gunshot missiles. Most investigators agree that the missile should be removed when located in the pulmonary artery and its branches because of the high risk of severe complications, such as pulmonary infarction, secondary thrombosis, infection, erosion of the arterial wall and local hemorrhage. In such instances, a thoracotomy is recommended. The alternative treatment in the instances reported herein, conceived and successfully performed by us, was embolectomy through percutaneous cardiovascular catheterization. As a novel procedure, the method has proved effective and liable to minimal risk.

Adult↗
PubMedDate not supplied

Aztreonam plus clindamycin vs. tobramycin plus clindamycin for the treatment of intraabdominal infections.

Sixty-six patients with acute intraabdominal infections due to gram-negative aerobic organisms were treated with aztreonam plus clindamycin or with tobramycin plus clindamycin in a multicenter, comparative, randomized study. The patients had undergone a variety of surgical procedures; most of them had peritonitis. Thirty-three of the 36 patients in the aztreonam group and 26 of the 30 patients in the tobramycin group had satisfactory clinical responses. Only one gram-negative aerobic pathogen, a strain of Pseudomonas aeruginosa, persisted after treatment; the patient involved was in the tobramycin group. The incidences of adverse reactions, superinfections, and abnormal laboratory values were low in each treatment group. The difference between the efficacies of the two regimens was not statistically significant. This study suggests that aztreonam may be a useful alternative to the aminoglycosides in the treatment of gram-negative intraabdominal infections.

Abdomen↗
PubMedDate not supplied

[Treatment of inguinal hernias. Is the Bassani's technique current yet? A prospective, randomized trial comparing three operative techniques: Bassini, Shouldice and McVay].

OBJECTIVE: To compare late results (recurrence) of three different techniques for treatment of inguinal hernias in the adult: Bassini, Shouldice and McVay. PATIENTS AND METHODS: The operative late results of three surgical techniques: Bassini, Shouldice and McVay in 119 adult patients with inguinal hernias (some with bilateral pathology, totalizing 136 hernias) were analyzed. The majority of patients were males (93.3%). The analysis was prospective, randomized, with uniform distribution of all three types of inguinal hernia (direct, indirect and combined) among the three groups of operative techniques. The number of recurrences was submitted to an actuarial analysis for a period of 4 years. The results underwent statistical analysis by the Kaplan-Mayer test with actuarial survival curves. RESULTS: Eight hernia operations by the Bassini technique recurred in this time span, 3 in the Shouldice group and 2 in McVay. Among the Bassini recurrences, the worst results were observed with direct hernias (29% recurrence) when compared with indirect ones (16% recurrence). Overall recurrence rates plotted in an actuarial survival curve for 4 years, revealed statistically significant differences between Bassini and Shouldice: 35.7% versus 23.7%; the same happened when comparing Bassini to McVay: 35.7% versus 8.5%. The differences between Shouldice and McVay were not significant. CONCLUSION: A recurrence rate of 35.7% for inguinal herniorraphy with the Bassini technique in a General Surgery University Clinic was surprising and obliged us to interrupt the trial. Our observations point to a prohibitive high failure rate when dealing with the Bassini technique, which was, over a century, the most popular treatment of inguinal hernia all over the world. Shouldice and McVay techniques, even though more complex, should be preferred whenever one makes the choice for "conventional" hernia treatment.

Adult↗