Search PubMed⌕ Search

Biomedical subjects

E Vitali

Publications and source records attributed to E Vitali.

At least 55 records · Page 3Linked to original sources
PubMed1990

Surgical treatment of the Wolff-Parkinson-White syndrome. Endocardial versus epicardial approach.

From 1983 to 1988, 51 patients with the Wolff-Parkinson-White syndrome underwent surgical ablation of an accessory conduction pathway, 25 by the classic endocardial approach and 26 by the epicardial technique supplemented by cryosurgery. In the endocardial and epicardial groups, the accessory pathway was in the left free wall in 22 and 18 patients, respectively, posterior septal in two and seven, and in the right free wall in one patient in each group. There was no early or late death in the endocardial group, and postoperative complications developed in five patients (20%). Pathway ablation was completely successful in 22 patients (88%), preexcitation recurred in two patients (8%), and one had recurrence of supraventricular tachycardia (4%). One of the failures occurred with a posterior septal pathway (50%), and the two others with a left free-wall pathway (9%). With the epicardial technique, there were no early deaths and one late death caused by atherosclerotic coronary artery disease. Five patients (19%) had postoperative complications. The pathway was ablated successfully in 22 patients (85%), preexcitation recurred in three patients (12%), and supraventricular tachycardia remained inducible in another patient despite disappearance of the delta wave. Three of those failures occurred with anterior left free-wall pathways (16%), but only one patient had recurrent supraventricular tachycardia (4%) requiring immediate reoperation, which was successful. In conclusion, although epicardial or endocardial approaches produced similar results, our observations suggest that left free-wall accessory pathways located high anteriorly may be ablated in a more reproducible way with the endocardial technique, whereas the epicardial approach appears easier for posterior septal pathways. We therefore believe that any surgeon beginning such surgery should be aware of the possibilities and limitations of each of the two techniques.

Adolescent↗
PubMed1987

Results of heart valve replacement with the SORIN prosthesis.

From March 1977 to December 1981, 872 patients at our institution underwent valve replacement with a pyrolytic carbon tilting disc prosthesis manufactured in Italy by SORIN-Biomedica. To verify the performance characteristics of this prosthesis, we analyzed the intermediate-term results obtained over a cumulative total of 3,041 patient-years (pt-yr) of follow-up. Three hundred sixty-nine patients underwent mitral valve replacement (MVR), 309 had aortic valve replacement (AVR), and 194 had both mitral and aortic (double) valve replacement (DVR). Expressed in actuarial terms (% [+/- standard error of the mean] free of adverse events at 5 years) and in linearized terms (% pt-yr), respectively, valve-related complications occurred at the following rates: Thromboembolism, 89.9 +/- 1.9% and 2.1 +/- 0.4% pt-yr (MVR); 92.1 +/- 1.9% and 1.7 +/- 0.4% (AVR); 90.5 +/- 5.0% and 2.2 +/- 0.6% (DVR). Anticoagulant-related hemorrhage, 95.2 +/- 1.5% and 1.4 +/- 0.3% (MVR); 95.9 +/- 1.5% and 1.3 +/- 0.3% (AVR); 96.0 +/- 2.0% and 0.9 +/- 0.4% (DVR). Prosthetic valve endocarditis, 99.0 +/- 0.6% and 0.2 +/- 0.1% (MVR); 97.4 +/- 1.0% and 0.6 +/- 0.2% (AVR); 94.5 +/- 1.7% and 1.4 +/- 0.4% (DVR). Reoperation, 92.6 +/- 1.5% and 1.7 +/- 0.3% (MVR); 89.4 +/- 1.9% and 2.4 +/- 0.4% (AVR); 82.3 +/- 2.9% and 4.8 +/- 0.8% (DVR). The total valve-related morbidity and mortality was 79.6 +/- 2.6% and 4.9 +/- 0.6% (MVR); 79.7 +/- 2.6% and 5.1 +/- 0.6% (AVR); 70.5 +/- 4.0% and 7.7 +/- 1.1% (DVR). The 5-year actuarial survival rate without hospital mortality was 86.8 +/- 2.0% (MVR), 91.0 +/- 1.7% (AVR), and 78.8 +/- 3.7% (DVR). The intermediate-term survival and complication rates showed the performance of the SORIN prosthesis to be quite satisfactory.

Journal Article↗
PubMed1985

Mycotic tuberculous aneurysm of the descending thoracic aorta.

Tuberculous aneurysm of the aorta is a rare and dangerous condition. Despite modern diagnostic and surgical techniques, it remains a challenge to recognize and treat. A successful resection of a false aneurysm of the descending aorta that ruptured into the lung of a 55-year-old woman is reported. A history of the patient and microscopic examination of the specimen indicated a diagnosis of tuberculosis. Antituberculosis chemotherapy was immediately implemented. The patient appears to be in good condition 8 months after operation; however, she remains under treatment for tuberculosis.

Journal Article↗
PubMed1985

Chronic traumatic aneurysms of the descending thoracic aorta.

Between 1970 and December 1984, 28 patients with post-traumatic chronic aneurysm of the descending thoracic aorta were consecutively operated on in our Division of Cardiac Surgery. Ages ranged from 16 to 66 years (mean 38 years); 25 were male and three were female. In all cases, a history of a major deceleration injury was documented. The interval between trauma and operation ranged from 2 to 50 years (mean 11.4 +/- 7.8). Twenty-three (82.1%) were asymptomatic. Only one operation was performed on an urgent basis for recurrent episodes of hemoptysis. All patients underwent resection with prosthetic tubulargraft (25 cases) and patch-graft (3 cases) replacements. In all patients but one, left heart bypass was employed. No hospital deaths, late deaths, paraplegia or graft-related complications occurred. Considering the risk of late rupture and the young age of most of the patients, surgery in chronic post-traumatic aneurysms of the descending thoracic aorta is always indicated. We consider left heart bypass a safe technique in preventing renal and medullar ischemic injuries.

Journal Article↗
PubMed1985

[Reinterventions on cardiac valve prosthesis].

From January 1978 to December 1984, 214 patients underwent a total of 243 reoperations for repair or replacement of a prosthetic heart valve. On the basis of the number of valve reoperations in the same anatomic position within the heart, the patients were divided into three groups. Overall hospital mortality was 23.4% (CL 20.3-26.7) in Group I (214 patients), 48% (CL 36.1-60.1) in Group II (25 patients), 25% (CL 3.3-62.6) in Group III (4 patients). Hospital mortality appeared to be related to urgency of reoperation (p less than 0.001 in Group I; p = 0.037 in Group II), primary indication for reoperation (p = 0.034 in Group I; p = 0.022 in Group II), association with other cardiac surgical procedures (p = 0.00253 in Group I). Hospital mortality in Group I was significantly higher (p = 0.0056) when reoperation was performed within one year after valve replacement. No significant differences in urgency and emergency rate were noted between reoperations on mechanical heart valves and bioprostheses. No significant differences in bleeding complications were noted between reoperations and initial valve replacement. Mean follow-up is 37.4 +/- 21.8 months (range 2 to 85 months). Actuarial survival rate is 82.8 +/- 3.1% at 1 year, 78.7 +/- 3.5% at 2 years and 71.5 +/- 5.1% at 5 years; 90.9% (CL 87.4-93.6) of the followed patients are in I or II NYHA class. The results appear to suggest that when significant (on clinical or instrumental criteria) prosthetic disfunction is diagnosed, reoperation should be undertaken early to minimize operative risk. The Authors point out that surgery in such patients also ensures satisfying long-term results.

Follow-Up Studies↗
PubMed1985

Intrapericardial hydatid cyst. Report of a case successfully operated.

Hydatid disease of the pericardium is rarely observed. The case of a 42-year-old man with intrapericardial hydatid cyst is presented. The first symptom of the disease was severe chest pain with electrocardiographic evidence of Q waves and T negative waves suggestive of myocardial necrosis. The two-dimensional echocardiography revealed large cystic image localized in the lateral-inferior wall of the left ventricle. Surgical treatment was carried out without the aid of cardiopulmonary by-pass, although this had been contemplated. The patient is asymptomatic and all electrocardiographic abnormalities regressed three months after the operation. The development, natural history, complications, diagnosis and surgical therapy of intrapericardial echinococcosis are discussed.

Adult↗
PubMed1983

[Use of digitalis in geriatrics: is it effective on the heart in sinus rhythm?].

The therapeutic activity of digitalis in cardiac failure is linked to its positive inotropic effect on the myocardium and its ability to control cardiac activity in atrial fibrillation. Chronic stimulation with digoxin in aged subjects with sinus rhythm, however, is of debatable utility Reference is made to a series of 35 subjects (mean age 76.5 yr) in sinus rhythm, 30 of whom had been taking digoxin for over 3 yr. Clinical and instrumental parameters were assessed and heart function was classified according to the NYHA arrangement. Subjects were randomly placed in two groups matched for sex, age and cardiac condition. The first group received digoxin, the second a placebo. No significant differences between the two groups were noted over a 3-month period. In keeping with the recent literature, it is felt that digitalis is not necessary for the dynamic cardiac control of aged subjects in sinus rhythm. In addition, it is suggested that hydrosaline retention in such subjects can be controlled by restriction of salt intake, rest and diuretics.

Aged↗
PubMed1983

[Emergencies in valvular surgery].

Ninety patients who underwent emergency cardiac valve surgery from January 1976 to December 1981 are reported. Patients were divided in two groups: those operated on native valves are included in group I; patients with prosthetic valves operated because of leakage or malfunction, in group II. In group I (57 patients) the aetiology was: rheumatic heart disease (34 cases); acute endocarditis (16 cases); sequelae of recent endocarditis (2 cases); luetic infection (1 case); sequelae of myocardial infarction (1 case); rupture of mitral chordae in mixomatous valve (3 cases). The emergency operation was prompted in 22 patients by cardiogenic shock, in 13 patients by intractable pulmonary edema, in 21 patients by low output syndrome, in one case by ventricular arrhythmias. In group II (33 cases) the causes of reoperation were: in 27 cases leakage (in 13 due to active endocarditis); in 6 cases variance of the occluder or thrombosis. The emergency originated in 12 cases from cardiogenic shock, in 11 cases from intractable pulmonary edema, in 9 cases from low output syndrome, in 1 case from ventricular arrhythmias. Twenty-six patients died perioperatively in group I and 17 in group II. Mean follow-up in group I was 26 months. Among 27 patients there were two deaths; 25 patients are alive and well (one has been reoperated again). Mean follow-up in group II was 21 months. Among the 15 patients observed there were 6 deaths (3 after re-reoperation); 9 patients are alive and well (one has been re-reoperated).' The Authors feel that surgery is mandatory in all such patients to ensure satisfying long term results, in spite of high perioperative mortality rate.

Adolescent↗
PubMed1980

[Aneurysms of the Valsalva sinus. Study of ten treated subjects (author's transl)].

The study includes 10 patients affected by aneurysm of Valsalva sinus who underwent surgery. The aneurysm involved the "non coronary" sinus in 5 cases and the right coronary sinus in 5. All the aneurysms prolapsed into the right cardiac chambers. Additional cardiac anomalies were present in 6 patients. 4 patients were asymptomatic, 2 were in NYHA class III and 4 in class IV and one was in cardiogenic shock. Indications for surgery were hemodynamic impairment due to the shunt and/or associated anomalies. Surgical treatment included resection of the aneurysm, suture of its orifice and correction of associated cardiac anomalies. Death only occurred in one patient, who arrived at surgery in cardiogenic shock. 8 patients were followed-up for a mean period of 40 months (range 11 to 84 months), after operation: satisfactory clinical conditions were found in all of them. A mild aortic regurgitation was only observed in one patient, 8 years after surgery.

Adolescent↗
PubMedDate not supplied

Correlation between extent of myocardial dysfunction and markers of irreversible damage in failing hearts.

BACKGROUND: The structural correlates of 201Tl uptake in patients with advanced postischemic pump dysfunction are unclear. There are no good experimental models adequately reflecting the mixture of normal, dysfunctional but viable, and necrotic regions characteristic of chronic ischemic heart disease in human beings. METHODS AND RESULTS: Four heart transplant candidates with idiopathic dilated cardiomyopathy and seven with ischemic heart disease underwent rest-injection 4-hour redistribution 201Tl single-photon emission computed tomography before surgery. Delayed tracer uptake was categorized into severely reduced (<50%), mildly or moderately reduced (50% to 74%), and normal (> or =75%) and related to echocardiographic wall motion and histologic findings in the hearts excised at transplantation. In idiopathic dilated cardiomyopathy, despite severe wall motion impairment, minimal or mild myocardial damage and homogeneously high 201Tl uptake were found. In ischemic heart disease, wall motion did not discriminate extensive from mild structural damage. 201Tl activity was inversely related to myocardial fibrosis (r = -0.50, p = 0.0001). Severe defects in 201Tl uptake (<50%) predicted extensive (>30%) fibrosis with 83% sensitivity and 63% specificity. Segmental akinesis and apical location resulted in loss of sensitivity (74% and 58%, respectively). No histologic or wall motion abnormality accounted for poor specificity. In the individual patient, more than nine segments determined viable by imaging criteria predicted left ventricular fibrosis of less than 15% with 86% accuracy. CONCLUSIONS: This histopathologic-clinical correlative study supports current evidence of good sensitivity but limited specificity of 201Tl rest-redistribution tomographic imaging in the evaluation of viable myocardium. In the individual patient, more than nine viable segments reliably predicted a limited extension of fibrosis.

Adult↗
PubMedDate not supplied

[Evaluation and treatment of the enuretic child: eight years' experience].

Enuresis is a common functional problem among children which is defined as a complete involuntary voiding of urine at an age which control should be present. Bed wetting generally resolves with increasing age, but the restriction in social life and the psychological secondary problems, so frequent in older patients, justify an appropriate treatment of the problem in the child over seven. At children's Hospital of Florence University an enuresis service exists since 1983, and during these years 541 children applied to the structure. 326 children completed the treatment, among these there were 202 boy and 124 girls with age between 6 and 19. All the patients have been initially helped only with conversation (motivational counseling) and 76 among them (23% of the whole) obtained permanent cure. The remaining 250 children were treated with the conditioning alarm system, always associated to periodic conversation, urine stop exercises and other psychological support (token economy, etc). There were 161 boys and 89 girls: 220 children had nocturnal primary enuresis and 30 secondary. The family history was positive in 77%. The results obtained of this kind of treatment after a follow-up of 6 months, were permanent recovery in 211 children (84%) and failure in 39 patients (16% of the cases). There have been 35 relaxes. Regarding the sex, no significant difference was noted. These positive results with the conditioning devices favor the view that the etiology of primary enuresis is mainly biologic. The bell alarm represents the most effective treatment for nocturnal enuresis included more than seven.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Epidemiologic data on breast feeding in Florence and the province. Survey carried out in 1364 children born between 1985 and 1987].

We have studied the breast-feeding frequency in Florentine Area. We investigate a group of 1364 children born between January 1985 and June 1987. We collected following data: 1) Kind of feeding at birth. 2) Duration of breast-feeding related with birth-weight, kind of delivery, mother's age, mother's working activity. 3) Growth in relation to feeding practices from birth to 3rd month. The percentage of infants breast-feed in the hospital was 81.6%, 50.5% at the end of third month, 21.9% at the end of sixth month. We have found that children weighing more than 3000 g at birth had an higher frequency of breast-feeding at birth and last longer than children weighing less than 3000 g (p less than 0.01). Maternal age had a clear effect on both the incidence and the duration of breast-feeding. Mother aged 30 years or more begin to breast-feed in lower percentage but they continue breast-feeding for a longer time. One of the factors that has a negative influence on breast-feeding at birth is caesarean section since it precludes early mother-infant contact and early initiation of breast-feeding. Mother's resume working has a negative influence on breast-feeding duration. With regard to growth in first three months of life related with different kind of feeding we have found no differences between breast-feeding and artificial-fed infants.

Age Factors↗
PubMedDate not supplied

Pregnancy in patients with mechanical prosthetic heart valves. Our experience regarding 98 pregnancies in 57 patients.

Ninety-eight pregnancies in 57 patients with mechanical (ball or tilting disc) prosthetic heart valves are described. Sixty-one pregnancies developed in 36 patients with a mitral prosthesis, 12 pregnancies in 9 patients with an aortic prosthesis, 17 pregnancies in 10 patients with both mitral and aortic prostheses and 8 pregnancies in 2 patients with mitral and tricuspid prostheses. All patients were in I or in II NYHA class at conception and no significative change was noted during pregnancy. All the patients were treated with oral anticoagulant therapy at conception. Different kinds of antithrombotic and antiembolic prophylaxis were employed. There were 13 voluntary interruptions of pregnancy and 37 spontaneous abortions. In the 47 newborn 2 malformation complications (1 warfarin syndrome, 1 cleft palate) and 4 haemorrhagic complications (without sequelae) were noted. Two fatal thromboses of a mitral prosthesis occurred; systemic embolic complications were noted in 7 cases. These observations suggested different incidences of complications regarding the antithrombotic and anti-embolic prophylaxis. The authors point out the high risk of thrombotic and embolic complications and the low rate of successful outcome of pregnancy in these patients.

Abortion, Spontaneous↗