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Biomedical subjects

F Caruso

Publications and source records attributed to F Caruso.

At least 73 records · Page 4Linked to original sources
PubMed1979

[Clinical and therapeutic considerations on bochdalek's congenital posterolateral diaphragmatic hernia (author's transl)].

The Authors describe 5 cases of Bochdalek's posterolateral diaphragmatic hernia in terms of their clinical, diagnostic, and therapeutic aspects. They also explain their criteria in the choice of surgical approaches and describe reconstruction methods used in the repair of large hernias. Finally, they propose a special schedule of postoperative management to be used in connection with neonatal surgery, where surgical mortality is still high.

Child, Preschool↗
PubMed1976

[Indications and limitations of bronchography in surgery of carcinoma of the lung].

Starting from a consecutive series of 53 bronchographies performed under local anesthesia, in subjects with carcinoma of the lung ascertained by operation, the Authors analyse both the bronchographical aspects which most frequently come under the surgeon's observation, and the usefulness of this investigation in formulating the operating plan. As regards carcinomas of the large and medium bronchi, the bronchographic aspects they found most frequently are occlusion (82%) both in the form of sudden arrest and in the form of a cone image and stenosis (18%). In peripheral carcinomas, on the other hand, most characteristic bronchographic signs are identified as occlusion (58%) (amputation and stenosis) and dislocation (38%) with rigidity of one or more small calibre bronchi (rigid impairment). On the basis of their experience the Authors conclude that bronchography constitutes an almost indispensable examination for diagnostic purposes in malignant neoplasias, especially in the initial stage, when located outside the field of action of bronchoscopy, and can supply elements indispensable in the preoperative operatability judgement. In fact it not only gives very reliable information on the anatomical situation of the bronchus, as well as on the site and presumed starting-point of the neoplasia, but also supplies more approximate elements with regard to the extent of the neoplasia and any presence of lymphoglandular metastases.

Bronchial Neoplasms↗
PubMedDate not supplied

Treatment of refractory metastatic breast cancer with 5-fluorouracil and levofolinic acid as 48 hours continuous venous infusion.

Twenty-four consecutive patients with metastatic breast carcinoma (MBC) refractory to first line chemotherapy were treated with high-dose folinic acid (FA) 100 mg/m2 diluted in 250 cc of normal saline as 2 hour infusion followed by 5-fluorouracil (5FU) 400 mg/m2 bolus then 5FU 600 mg/m2 as continuous infusion for 22 hours. This therapy was repeated for 2 consecutive days. Chemotherapy was repeated every 15 days. All enrolled patients were evaluable for objective response. A complete response was achieved in 1 patient (4%) and a partial response in 6 cases (25%) for an overall response rate of 29% (confidence limits 18%-39%). The median duration of objective responses was 8.4+ months (range 3.0+/12.8). Six patients showed no change (25%) with a median duration of 4.0 months 11 patients progressed (46%). A subjective improvement in tumor-related symptoms was reported by all responding patients and in 3 patients with no change. Most patients (7/10) with symptomatic bone lesions had a subjective improvement with reduction in analgesic drugs consumption. Objective responses were observed at all sites of disease. In fact, responses were seen in the skin liver lung bore and rodal metastases. The median overall survival was 13.0+ months (range 4.0/16.2+). Over a total of 160 cycles (a mean of 6.6 cycles/patient) grade 1-2 leukopenia was seen in 9 patients (37%) grade 1 thrombocytopenia in 4 patients (17%) and grade 1 anemia in only 2 cases (8%). Grade 3-4 leukopenia or thrombocytopenia were not seen. Phlebitis at the injection vein occurred in 3/10 patients (30%) which refused to implant a central line. In patients with a central line or a port-a-cath no cases of vascular, toxicity were seen. Gastrointestinal toxicity was very mild with 9 patients (37%) suffering from grade 1-2 nausea/vomiting 6 patients (25%) complaining of grade 1-2 diarrhea and 6 patients with grade 1-2 stomatitis. Hand-foot syndrome was observed in only 1 patient. No cases of grade 3-4 gastrointestinal toxicities have been, observed. No cases of cardiotoxicity and/or neurotoxicity were recorded. The combination of high-dose FA and 5FU given as 48 hour continuous venous infusion every 2 weeks is active, at least in terms of objective response rate and tumor-related symptoms palliation against anthracycline-refractory MBC. These results compare favorably with bolus administration of FA and 5FU or other salvage regimens.

Adult↗
PubMedDate not supplied

Treatment of refractory metastatic breast cancer with 5-fluorouracil plus levofolinic acid as continuous venous infusion: a phase II study.

Effective palliation of metastatic breast carcinoma (MBC) after the failure of front-line chemotherapy for advanced disease, often based on the use of anthracyclines and taxanes, is quite difficult to achieve due to the development of dominant neoplastic cellular clones highly resistant to further therapy. Therefore the therapeutic index of second and third line chemotherapeutic treatments is usually quite low. Thirty patients with MBC with progressive disease after anthracycline-based chemotherapy as first line therapy were treated with l-FA 100 mg/m2/day and 5FU 1000 mg/m2/day ad continuous venous infusion for 96 hours every 4 weeks. Most patients (60%) had multiple sites of disease at entry and had visceral lesions as the dominant site of disease. Twenty-eight patients were evaluated for objective response: two patients had clinically progressive disease before restaging after the third cycle of chemotherapy. These patients were considered progressive disease since all patients were included in an intent-to-treat analysis. Nine patients achieved partial response for an overall response rate of 30% (intent-to-treat analysis) with a median duration of 9.5+ months (range 4.0/14.0 months), and disease stability was obtained in 10 cases (33%) with a median duration of 5.5 months (5-11). Progressive disease was recorded in 9 patients. After a median follow-up of 11 months, the overall median survival time of the whole series of patients was 14.0+ months. Objective responses were recorded both at visceral and bone sites. Chemotherapeutic treatment was generally quite well tolerated. No toxic deaths were recorded. Among gastrointestinal side-effects grade 3 stomatitis was noted in 30% of patients, and grade 3 diarrhea in 10% of cases. Grade 3-4 leukopenia was observed in 23% of patients, but significant episodes of febrile neutropenia were limited (2 patients). Grade 3 thrombocytopenia was seen only occasionally in 1 patient. Grade 1 anemia was recorded in 10% of patients. Hand-foot syndrome was noted in 2 patients (7%). Cardiotoxicity was minimal. The combination of 5FU and high-dose I-FA given as 96 hour continuous venous infusion was active, at least in terms of the overall response rate, against anthracycline refractory metastatic breast carcinoma. These results compare favourably with bolus 5FU/FA or other salvage regimens in terms of antineoplastic activity, and is well tolerated both subjectively and objectively by most patients.

Adult↗
PubMedDate not supplied

[The measurement of vascular access recirculation and intra-access pressure in arteriovenous fistula monitoring in hemodialysis].

BACKGROUND: The main objective of monitoring vascular access flow in haemodialysis is maintenance of adequate access blood flow (Qac ) to prevent underdialysis and detection of haemodynamically significant stenosis prior to thrombosis. METHODS: Recirculation and intra-access pressure were measured to monitor arteriovenous fistulae in a group of haemodialysed patients, for a period of six months. Vascular access blood flow measurements were taken at the first (t0), second (t1) and sixth month (t2) by recirculation measurements using the thermodilution technique (BTM) consistent with Krivitsky's theory. Intra-access pressure measurements were made using the simplified Besarab's method. RESULTS: No statistically significant differences were noted in recirculation, vascular access blood flow, cardiac output and intra-access measurements during the three periods of the study. Vascular access blood flow was significantly and positively correlated with the arterial blood pressure measured at the same time, but not with the intra-access and venous pressures. Data indicate that mean Qac values = 300 mL/m. and induced recirculation values (Rp) = 45 and = 50 are correlated with angiographic findings of vascular access dysfunction. We observed that patients with mean Qac values between 300 and 650 mL/m had negative angiograms. CONCLUSIONS: We conclude that calculation of access flow by the double recirculation technique is a better and earlier predictor of access dysfunction whereas intra-access pressure measurements are not as useful for this purpose.

Aged↗
PubMedDate not supplied

[Impact of left ventricular patterns and diastolic dysfunction on hemodialysis patients].

BACKGROUND: Left ventricular hypertrophy is the main manifestation of uraemic cardiomyopathy and predicts both cardiovascular events and death independently of conventional risk factors. Diastolic dysfunction is often associated with left ventricular hypertrophy, and accounts for up to 30% of heart failure. The aim of this study was to estimate the impact and the prevalence of left ventricular hypertrophy, its geometric models and diastolic dysfunction on haemodialysis patients, as well as the relationship with cardiac troponin, a specific marker for myocardial damage. METHODS: We enrolled in the study 31 patients (26 on haemodialysis, 5 on peritoneal dialysis) and 31 normal healthy subjects as the control group. Echocardiographic measurements were carried out according to the recommendations of the American Society of Echocardiography. Left ventricular mass was calculated according to the Devereux formula and indexed to height 2.7 We carried out Doppler echocardiography to study the diastolic function by measurements of isovolumic relaxation period (IVRT), E-wave deceleration time (DTE) and E/A ratio. We measured cardiac troponin using a third generation electrochemiluminescence immunoassay. We did the statistical analysis with the t test for comparison among groups, and we established correlations using the Pearson and Spearman correlation test. We considered values of p<0.05 to be statistically significant. RESULTS: Eccentric hypertrophy was the most frequent pattern (n=17; 55%), followed by normal cardiac geometry (n=7; 23%) and concentric hypertrophy (n=5; 16%). Only a minority of patients (n=2; 6%) showed concentric remodelling. Systolic dysfunction was present in 3 patients (EF<50%). Diastolic dysfunction was present in 24 out of 31 HD patients, that had abnormal relaxation pattern, characterised by prolonged IVRT, prolonged DTE and E/A ratio <1. Only one patient had restrictive filling pattern with reduced DTE and E/A ratio >2. Fourteen patients (45%) had E/A ratio < or =0.5, 10 patients (32%) had E/A ratio >0.5<1 and 7 patients (13%) had E/A ratio > or =1. DTE was prolonged in 14 patients (45%) and IVRT was prolonged in 6 patients (19%). The patients with E/A ratio < or =0.5 (n=14; 45%) suffered major hypotensive episodes during dialytic sessions compared to patients with E/A ratio >0.5, we found this difference to be statistically significant (p < 0.01). We observed the E/A ratio to be negatively correlated with age (r = -0.41; p=0.02) whereas DTE was positively correlated with posterior wall thickness (r =0.36; p= 0.05) and interventricular septum thickness (r =0.45; p=0.01). Cardiac troponin was positively correlated with age (r =0.50; p=0.00), left ventricular mass (r =0.41; p=0.02), posterior wall thickness (r =0.41; p=0.02) and interventricular septum thickness (r =0.39; p=0.03) but not with diastolic dysfunction parameters. Serum cardiac troponin was elevated (> or =0.10 micro g/L) in 12 patients (38.7%) and was associated with eccentric hypertrophy in all the cases. We detected no significant differences among groups with normal left ventricular geometry and left ventricular hypertrophy in the duration of the dialytic treatment, but we noted a statistically significant difference in relationship to age (p=0.03). CONCLUSIONS: Left ventricular hypertrophy is associated with diastolic dysfunction, both cause of hypotensive episodes during dialytic treatments and heart failure in patients with normal systolic function. The non invasive assessment of left ventricular diastolic function would represent an important advancement in the diagnosis and prevention of heart failure in haemodialysis patients.

Diastole↗
PubMedDate not supplied

[Early kidney-pancreas transplantation in type 1 diabetics prevents hemodialysis].

BACKGROUND: The life-expectancy of type 1 diabetics (T1D) on dialysis is still shorter than that of non-diabetics. Pancreas transplantation (PT) in its different modalities should be considered as a life-saving procedure. METHODS: We analyzed our referral activity of T1D to PT from 1992. Since 2002, we have created a kidney and diabetes out-patient clinic devoted to the prevention of diabetic nephropathy and to the early referral of suitable T1D to combined kidney- pancreas transplantation (KPT) and isolated pancreas (PTA). RESULTS: In the last 14 yrs, 25 T1D underwent KP in our district (620000 inhabitants). At the beginning, KPT was performed abroad, but then the borders were closed. After stopping in the mid 1990s, KP activity restarted addressing preemptive KPT and PTA. Currently, only one patient is on dialysis while awaiting KPT. Four T1D were evaluated and excluded from the list on medical grounds; two patients are on the list and a further two patients are currently under evaluation. CONCLUSIONS: The implementation of a cooperative network among dialysis and transplant centers, supported by devoted out-patient clinics allowed the effective prevention of the dialysis requirement in T1D. Out-patient clinics devoted to diabetic nephropathy should play a pro-active role in preemptive KP, including the 'new' option of islet transplantation according to the Edmonton protocol.

Diabetes Mellitus, Type 1↗
PubMedDate not supplied

[Laser in periodontology: theoretical-experimental approach. 3. Experimental study of the effects of He-Ne (638 nm) and infrared diodic (904 nm) lasers on the gingival mucosa of rats].

Medical and surgical laser-therapy is becoming more and more important in various branches of Medicine, however independently from clinical results still very little is known about physical-biological interaction between laser beam and living matter. The aim of this study is of finding tissutal and cellular effects of stimulation with soft and mid laser. The study started from an original work carried out at the Institute of Biology of the 1st Faculty of Medicine and Surgery of Naples University from which appears the possibility of visualizing the stage of nuclear active synthesis of the cell, simply by Maloory tricromic colouring. By this method the cellular nucleuses take, usually, a red colour, however in presence of an increase of the RNA nuclear synthesis the nucleuses take a typical blue colour. The importance of the study induced us to research the presence in the oral mucose of the rat after radiation as an effect of biostimulation. The results of this study showed and increase of the epithelial cheratine and a variation of the disposition and of the number of the precheratine grains in treated site. The blue nucleuses have been found at the basal level without any difference between treated and control site. On the other hand their presence is the normal consequence of the epithelial evolution which starts from the basal level which is the most active in the stage of nuclear synthesis.

Animals↗