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Biomedical subjects

F Ferri

Publications and source records attributed to F Ferri.

At least 19 recordsLinked to original sources

[The use of laryngeal mask airway in esophagogastroduodenoscopy in children].

BACKGROUND: The use of laryngeal mask airway (LMA) for inducing and maintaining sedation during EGDS has never been reported in the literature but for a brief letter written by Gajraj in 1996. This study proposes the use of sevoflurane administered through LMA. METHODS: At the Pediatric Clinic of the University of Rome "La Sapienza" 80 children un-derwent EGDS. After premedication, immediate 8% sevoflurane and 60/40% N2O/O2 induction was delivered. Concentration of sevoflurane was reduced to 1% for maintaining general anesthesia. Heart rate (HR), systemic blood pressure (SBP), respiratory rate (RR), EtCO2 and SpO2 were not invasively monitored. Time for induction, time for emergence as well as complications, if any, were also evaluated. RESULTS: The monitored parameters did not show any significant changes. The time for loss of eyelash reflex and the time for end of induction were of 121+/-15 sec. 3.5+/-1.3 min respectively. The time for emergence was 3.4+/-1.8 min. Only minor complications were reported. CONCLUSIONS: The results obtained show that the use of LMA associated to sevoflurane as single inhaling agent can be a valid technique for EGDS in pediatric patients.

Anesthesia Recovery Period↗

Gasless laparoscopic-assisted ileostomy or colostomy closure using an abdominal wall-lifting device.

BACKGROUND: Restoration of intestinal continuity in patients with ileostomy after total colectomy or with colostomy after Hartmann's procedure is a major operation. Herein we illustrate the validity of gasless laparoscopically assisted reversal using abdominal wall lifting. METHODS: The operation was performed on 10 patients from February 1997 to May 1999. Seven of them had a left iliac stoma after a Hartmann resection, and three had an ileostomy after total colectomy. RESULTS: The laparoscopic reversal was completed in eight patients; the two others were converted to an open procedure. Three major complications occurred (30%). There were no deaths. The average operation time was 192 min (range, 125-265). Time of discharge from surgery averaged 9.5 days. Mean follow-up of these patients was 12 months and negative. CONCLUSIONS: Laparoscopically assisted ileo- or colorectal anastomosis without pneumoperitoneum and using a laparotenser can be considered for the reversal of patients with ileostomy or colostomy. Even taking the high rate of intraoperative or postoperative complications into consideration, the advantages that make such a laparoscopic approach suitable include reduced trauma related to a second major abdominal operation, reduced postoperative pain, and fewer cutaneous tissues exposed to bacterial contamination. Moreover, the use of a laparotenser makes it possible to operate on elderly patients with cardiovascular diseases. In the absence of pneumoperitoneum, it becomes possible to use traditional instruments, with a consequent reduction in costs.

Abdominal Muscles↗

Growth kinetics and structure of fibrin gels.

The structure and kinetics of fibrin gels grown from fibrinogen solutions under quasiphysiological conditions, but in absence of Ca++, were investigated by means of elastic light scattering. By combining classical light scattering and low-angle elastic light scattering, an overall wave-vector range of about three decades was spanned, from q approximately 3 x 10(2) to q approximately 3 x 10(5) cm(-1). The scattered intensity distribution of the gels was measured in absolute units and fitted to a single function, which was able to reproduce accurately the data over the entire wave-vector range. From the fitting, it was possible to estimate the average diameter d of the fibrin fibers, the average crossover length xi of the gel, and establish the fractal nature of the gel structure, with a measure of its fractal dimension D(m). The measure of the intensity in absolute units also allowed the estimate of the density rho of the fibrin fibers and provided an independent measure of their size. The kinetics of formation of the gel was described in terms of a simple growth model: the scaffold of the network is formed very early in the course of the gelation process, at a "networking time," t(n), which is much smaller than the time required to form the final gel. At times t>t(n), the gel structure remains substantially unchanged and the successive growth consists only in a thickening of the gel fibers. Gels prepared under the same physical-chemical conditions, but at different fibrinogen concentrations, exhibited rather similar structures and kinetics, showing that the modalities of the gelation process are mainly governed by the solution conditions, and only secondarily by the fibrinogen concentration. For gels at fibrinogen concentration of approximately 0.24 mg/ml, the gel parameters were d approximately 130 nm, xi approximately 27 microm, D(m) approximately 1.3, and rho approximately 0.4 g/cm(3). Our d and rho values are in very good agreement with electron microscopy- and turbidity-derived literature data, respectively, while xi seems to be related to the mesh size of the initial scaffold formed at t(n), rather than to the mesh size of the final aged gel.

Fibrin↗

Erythropoietin therapy and preoperative autologous blood donation in children undergoing open heart surgery.

We assessed the feasibility and efficacy of subcutaneous erythropoietin alpha (EPO) therapy and preoperative autologous blood donation (ABD) in children undergoing open heart surgery. Thirty-nine children were treated consecutively with EPO (100 U x kg(-1) s.c. three times a week in the 3 weeks preceding the operation and i.v. on the day of surgery) and two ABDs were made (Group 1). As controls to compare transfusion requirements, 39 consecutive age-matched patients who had undergone open heart surgery during the two preceding years were selected (Group 2). In a mean time of 20 (SD 5) days, 96% of scheduled ABDs were performed and only three mild vasovagal reactions were observed. The mean volume of autologous red blood cells (RBC) collected was 6 (1) ml x kg(-1) and the mean volume of autologous RBC produced as a result of EPO therapy before surgery was 7 (3) ml x kg(-1), corresponding to a 28 (11)% increase in circulating RBC volume. The mean volume of autologous RBC collected was not different from that produced [6 (1) vs 7 (3) ml x kg(-1), P=0.4]. Allogenic blood was administered to three out of 39 children in Group 1 (7.7%) and to 24 out of 39 (61.5%) in Group 2. Treatment with subcutaneous EPO increases the amount of autologous blood that can be collected and minimizes allogenic blood exposure in children undergoing open heart surgery.

Adolescent↗

Early events in the polymerization of fibrin.

The early events in the thrombin-induced formation of fibrin have been studied by the use of stopped-flow multiangle laser light scattering (SF-MALLS). This technological advancement has allowed the recovering, as a function of time with a resolution of about 0.5 sec, of the mean square radius of gyration (Rg2)z and of the molecular weight Mw, and to place an upper bound to the values of the mass/unit length ML. The ionic strength, pH and salt type conditions investigated were all close to physiological, starting with a 50 mM Tris, 104 mM NaCl, pH 7.4 buffer (TBS), to which either 1 mM EDTA-Na2 or 2.5 mM CaCl2 were also added. Fibrinogen was 0.2-0.3 mg/ml and rate-limiting concentrations of thrombin were used (0.05-0.25 NIH units/mg fibrinogen). By plotting (Rg2)z and ML versus Mw on log-log scales, runs proceeding at different velocities and under different solvent conditions could be compared and confronted with model curves. It was found that: (1) within this thrombin range, the mechanism of association does not depend on its concentration, nor on the buffers employed; (2) the (Rg2)z versus Mw curves could all be reasonably fitted with a bifunctional polycondensation scheme involving semiflexible worm-like, double-stranded, half-staggered polymers with persistence length between 200-600 nm, provided that a ratio Q = 16 between the rate of release of the two fibrinopeptides A was employed; (3) the ML versus Mw data seemed more compatible with lower Q values (4 < Q < 8), but their uncertainty prevented a better assessment of this issue; the formation of fibrinogen-fibrin monomer complexes may also play a role in the polymer distributions; (4) in the very early stages (e.g., when Mw < 7 x 10(5)), the (Rg2)z versus Mw data were fitted well only in TBS and at the lowest thrombin concentration, suggesting that a transient, either sequential or concurrent fast second mechanism, involving longer and thinner polymers, may be at work.

Biopolymers↗

Polymerization of rod-like macromolecular monomers studied by stopped-flow, multiangle light scattering: set-up, data processing, and application to fibrin formation.

Many biological supramolecular structures are formed by polymerization of macromolecular monomers. Light scattering techniques can provide structural information from such systems, if suitable procedures are used to collect the data and then to extract the relevant parameters. We present an experimental set-up in which a commercial multiangle laser light scattering photometer is linked to a stopped-flow mixer, allowing, in principle, the time-resolved extrapolation of the weight-average molecular weight M(w) and of the z-average square radius of gyration (z) of the polymers from Zimm-like plots. However, if elongated structures are formed as the polymerization proceeds, curved plots rapidly arise, from which M(w) and (z) cannot be recovered by linear fitting. To verify the correctness of a polynomial fitting procedure, polydisperse collections of rod-like or worm-like particles of different lengths, generated at various stages during bifunctional polycondensations of rod-like macromolecular monomers, were considered. Then, the angular dependence of their time-averaged scattered intensity was calculated in the Rayleigh-Gans-Debye approximation, with random and systematic noise also added to the data. For relatively narrow size distributions, a third-degree polynomial fitting gave satisfactory results across a broad range of conversion degrees, yielding M(w) and (z) values within 2% and no greater than 10-20%, respectively, of the calculated values. When more broad size distributions were analyzed, the procedure still performed well for semiflexible polymers, but started to seriously underestimate both M(w) and (z) when rigid rod-like particles were analyzed, even at relatively low conversion degrees. The data were also analyzed in the framework of the Casassa approximation, from which the mass per unit length of the polymers can be derived. These procedures were applied to a set of data taken on the early stages of the thrombin-catalyzed polymerization of fibrinogen, a rod-like macromolecule approximately 50 nm long. The polymers, grown in the absence of Ca(2+) by rate-limiting amounts of thrombin, appeared to be characterized by a much broader size distribution than the one expected for a classical Flory bifunctional polycondensation, and they seem to behave as relatively flexible worm-like double-stranded chains. Evidence for the formation of fibrinogen-fibrin monomer complexes is also inferred from the time dependence of the mass/length ratio. However, our data are also compatible with the presence of limited amounts of single-stranded structures in the very early stages, either as a secondary, less populated pathway, or as transient intermediates to the classical double-stranded fibrils.

Chromatography, High Pressure Liquid↗

Incisional hernia and fascial defect following laparoscopic surgery.

Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, Italy. Incisional hernia incidence is 1%. Risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. Malnutrition may have a major role in many cases. Calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.

Adult↗

[Spigelian hernia: an up-to-date].

Nine cases of Spigelian hernia occurred and surgically treated in the years 1992-1997 are reported. Spigelian hernias were observed in 5 females and 3 males with mean age of 62.1 years (range 49-70). In 5 cases prosthetic repair has been done with preperitoneal mesh and a very good outcome. In a 61 years old obese female spigelian hernia was bilateral. Her left sided hernia needed an emergency operation for strangulation. Hernia has been repaired by simple suture and recurred early. For the diagnosis of Spigelian hernia it is essential to remember it inside the "Spigelian belt". The satisfactory results obtained at present by prosthetic repair are underlined.

Aged↗

Positive and sustained effects of highly active antiretroviral therapy on HIV-1-associated neurocognitive impairment.

OBJECTIVES: To determine whether highly active antiretroviral therapy (HAART) is effective in HIV-associated neurocognitive impairment. DESIGN: An open label, prospective, observational study. METHODS: Since April 1996, 116 patients with advanced HIV infection, reverse transcriptase inhibitor (nRTI) experienced but protease inhibitor (PI) naive, were screened for the presence of neurocognitive impairment. Ninety patients with confounding neurological illness, opportunistic infections or drug abuse were excluded. The remaining 26 patients underwent comprehensive neuropsychological testing, and laboratory measures before, after 6 and after 15 months of treatment with one PI plus two nRTI. RESULTS: The prevalence of neurocognitive impairment decreased from 80.8% (baseline) to 50.0% (P<0.05) (sixth month) and to 21.7% (P<0.001) (15th month). Among the functions explored, the impairment of concentration and speed of mental processing decreased from 65.4 to 21.7% (P<0.01) and of memory impairment from 50 to 8.7% (P<0.01). Comparing baseline with the sixth and 15th month raw scores, a statistically significant improvement was seen in measures exploring concentration and speed of mental processing (P<0.05), mental flexibility (P<0.05), memory (P<0.05), fine motor functions (P<0.05) and visuospatial and constructional abilities (P<0.01). After 6 months of HAART patients with a normal neuropsychological examination had lower mean plasma viraemia (2.95 versus 3.97 log copies/ml, P<0.05) and greater mean log plasma HIV RNA changes from baseline (-1.84 versus -0.83 log copies/ml, P<0.05) than neuropsychologically impaired subjects. CONCLUSION: HAART produces a positive and sustained effect on neurocognitive impairment in HIV-infected patients. A reduction of plasma viral load was associated with the regression of neuropsychological test abnormalities.

Adult↗

Incisional hernia and fascial defect following laparoscopic surgery.

Complications involving the abdominal wall, particularly incisional hernias, were not expected when laparoscopic procedures were first introduced. With the increasing number of laparoscopies in abdominal surgery, more incisional hernias are observed. The authors report 13 cases of umbilical incisional hernia, which occurred late after laparoscopic cholecystectomy, and one case of omental procidentia through a lateral port, which occurred early after laparoscopic hernia repair with the transabdominal preperitoneal technique. There are 4 men and 10 women (mean age, 59.8 years; range, 40-74 years). Between March 1991 and December 1997, a total of 1,287 patients underwent laparoscopic operations at the Surgical Department of the Gradenigo Hospital in Turin, Italy. Incisional hernia incidence is 1%. Risk factors, such as chronic bronchitis or weight increase, which give rise to endoabdominal pressure, are present in some cases. Malnutrition may have a major role in many cases. Calculi larger than 15 mm are also seen frequently. Postlaparoscopy incisional hernia is generally a minor complication--only once did its occurrence cause a strangulated hernia. All precautions, including fascial suturing, must be taken to reduce the 1% incidence of postoperative incisional hernias.

Adult↗

Sporadic hepatitis C virus infection: a case-control study of transmission routes in a selected hospital sample of the general population in Italy.

A case-control study was performed on 9,175 Italian adult outpatients in 5 hospitals in Rome. The study was carried out to clarify the role of some less investigated risk factors (RF) in the spread of hepatitis C virus (HCV) infection. All subjects were contacted by interviewers, who completed a questionnaire. Their sera were stored and subsequently tested for both HCV and hepatitis B virus core (HBc) antibodies. 365 subjects, positive for anti-HCV and anti-HBc-negative, and who had denied intravenous drug use (IDU) (cases) were compared with an equal number of suitable random controls negative for anti-HCV and anti-HBc. Gender, age and region of birth and residence were matched. The prevalence of 13 RFs were statistically compared by univariate and multivariate analysis. A positive anti-HCV test was significantly associated, by multivariate analysis with intravenous treatments and minor surgical procedures (both before 1975) (p < 0.001), blood transfusions (before 1991) (p < 0.01), diabetes (p < 0.01), and deliveries in hospital (p < 0.05) (both before 1975). After 1975 (1991 for transfusions), all associations lost their significance. Intra-familial (sexual and non sexual), occupational RFs and dental care were not significantly associated with the presence of anti-HCV. We suggest that non-disposable syringes, commonly used until 1975 in Italy for i.v. treatments, have been the major route for HCV transmission in Italy among non-IDU subjects.

Adult↗

SeCD electronic folder: CADMIO's application for the medical folder of a service for the care of drug addicts.

In this paper we will describe the SeCD (Service for the Care of Drug addicts) electronic folder, a specific application of CADMIO [1] (Computer Aided Design for Medical Information Objects) system. CADMIO is a system for the definition, construction and management of multimedia clinical folders. The Ser.T. (Servizio per la Tossicodipendenza/Service for Drug Addicts) has earned a very special place within the Italian clinical structures as well as any service for drug addicts has done in the rest of the world. Such a structure has special needs and the characteristics of its medical folders are very different from any other folder. Actually, a Ser.T. has to keep updated the patient situation either from the clinical point of view as well as the psychiatric one. Moreover, it must keep track of the clinician subjective considerations about the patient psychic state and his situation in regard of the law. So, we had to redesign some of the features of the existing CADMIO application, to accommodate such highly not structured data into objects easily manipulated by an informative system. The objectives we hope to achieve were mainly two: To show that a well designed adaptive system can be easily exploited to support even very complex and poorly structured data types and actions To design data structures able to accommodate medical, psychiatric and administrative data in an homogeneous manner.

Computer Systems↗

[Blood lead levels in children from a ceramic center with respect to residence and parental occupation].

In a survey carried out in 1981, Pb exposure of children living in two geographical areas of the district of Scandiano and attending the first year of primary school was studied. The two areas were different concerning both traffic and the presence of ceramic tile industries, thus suggesting a different exposure of children. The survey demonstrated blood lead levels (PbB) markedly higher than 10 micrograms/100 ml, a value recently identified by the Centers for Disease Control (CDC, Atlanta, USA) as the limit beyond which children's learning capacity may be damaged. It was evident that both the occupational exposure of parents and, to a lower extent, the residence in zones with higher levels of pollution influenced PbB levels. During the last ten years significant improvements have led to the reduction of atmospheric emissions and of occupational exposure of ceramic workers. A new survey has been carried out in 1995. We examined 147 children attending the first year of primary school, and living in two zones for which a different level of Pb exposure could be assumed. In both zones, a clear reduction of PbB was observed in comparison with data obtained in 1981. Mean and standard deviation for PbB in the two groups were 4.1 +/- 1.71 and 4.5 +/- 2.04 micrograms/100 ml, with median values of 3.7 and 4.0 micrograms/100 ml, respectively. Only two cases (1.4%) exceeded the limit values proposed by CDC. Although the mean PbB were much lower than those observed in 1981, higher PbB were found in children whose parents were occupationally exposed to Pb. Maternal exposure seems to be particularly important in determining PbB in children. In comparison with data from the international literature, our results are very close to those obtained for children living in Scandinavian countries, in Germany or in France and rather different from those obtained by other authors in Italy.

Air Pollutants↗

[Lead exposure in the ceramic tile industry: time trends and current exposure levels].

There is a high density of industries for the production of ceramic tiles in the District of Scandiano (province of Reggio Emilia, Emilia Romagna region). In this area, since the beginning of 1970s, the time trend of Pb exposure in ceramic tile plants has been evaluated by means of biological monitoring (BM) data collected at the Service of Prevention and Safety in the Work Environment and its associated Toxicology Laboratory. From these data, a clear decreasing time trend of exposure levels is documented, the reduction being more evident during the seventies and in 1985-88. During the seventies BM was introduced systematically in all ceramic tile plants with the determination of delta-aminolevulinic acid in urine (ALA-U). As a consequence of the BM programme, hygienic measures for the abatement of pollution inside the plants were implemented, and a reduction, from 20.6% to 2%, of ALA-U values exceeding 10 mg/l, was observed. In 1985, the determination of lead in blood (PbB) replaced that of ALA-U in the BM programmes and highlighted the persistence of high level of exposure to Pb, which could not be outlined by means of ALA-U because of its lower sensitivity. PbB levels were 36.1 micrograms/100 ml and 25.7 micrograms/100 ml in male and female workers, respectively. These results required the implementation, within the plants, of additional hygienic measures and a significant reduction of PbB was obtained in the following three years. In 1988 PbB levels were 26.0 +/- 10.7 and 21.6 +/- 10.3 micrograms/100 ml in male and female workers, respectively. In 1993-95 Pb levels were obtained from 1328 male and 771 female workers of 56 plants, accounting for about 40% of the total number of workers in the ceramic industry, in the zones of Sassuolo and Scandiano. Exposure levels are not different from those observed in the preceding years, with PbB levels of 25.3 +/- 11.1 and 19.1 +/- 9.2 micrograms/100 ml in male and female workers, respectively.

Adult↗

Toward a general model for the description of multimedia clinical data.

The patient folder integrates information originating from heterogeneous sources. For this reason computerized tools for patient data management should exploit the advantages of multimediality and offer an integrated environment for data presentation, and image and biosignal visualization. Object-oriented modeling is the best approach for designing systems for multimedia patient folder management. We propose an object-oriented model, able to define the entities constituting the patient folder and their logical organization. This model has sufficient flexibility to adapt to the most varied clinical environments. It allows the physician to structure the information needed for his/her patient folder without employing a programming language.

Computer Simulation↗

A system to define and allocate health care resources on a territory to improve the life quality of the populations in developing countries.

In this paper the health resource allocation problem is discussed. An object-oriented system is proposed and its implemented prototype is illustrated. It consists of two parts: a Geographical Information System, which is able to acquire and store both geographical and social-epidemiological information (including the resource distribution on that territory), and a Decision Support System, able to decide, using optimization algorithms, the new resource allocation in order to obtain a quasi-optimal solution for the cost/benefit ratio minimization problem, after having fixed the goal (e.g., the decrease of the incidence of a given disease) and constraints (e.g., a fixed budget, a given set of available resources, etc.). The object-oriented database which is part of the system can simulate and store different scenarios, depending on the different goals and constraints defined in input, by means of a user friendly interface.

Algorithms↗

[Prosthetic repair of inguino-crural hernia using Rives technique].

The authors report their experience with Rives procedure, a prosthetic repair of groin hernias using preperitoneal sutured mesh by parainguinal access. This operation is not technically easy to perform and is usually done out of necessity in cases with higher risk of recurrence because of systemic factors of chronic abdominal high pressure and/or of local factors of risk, when there are contraindications to operations like Stoppa procedure. Our series report 38 patients operated upon on 5 years, with incidence of 5.8% overall hernias repaired in the same period. 33 are males, 5 females, with average age of 60.5 years. Mean time required for the operation is 94 minutes (range 55'-130'). About postoperative complications we complain of one testicular atrophy, but none infections. Follow-up range is 9-50 months (average 23.2 months) for 30 patients operated more than one year ago. All but one were revisited after almost 12 months. No recurrences were detected.

Adult↗

[Stoppa's intervention. The complications nd results].

The authors report their experience with the giant prosthetic reinforcement of the visceral sac (Stoppa procedure), developed in the last 6 years operating 126 cases. Postoperative period was regular for two third of the patients, but only in 4 cases we can consider complication severe: 2 cases of preperitoneal haemorrhage with haematoma formation and subsequent recurrence; one sepsis of the preperitoneal space around the prosthesis, cured with drainage and conservative measures without recurrence, and then one peritonitis in a morbid obese individual. There was no mortality. 93.3% of the patients has been clinically controlled after over 6 months (average 27 months; range 6-67 months): 8 recurrences have been observed (3.6% of the hernias operated). 7 required reintervention. Therefore it is possible to affirm that 91% of the operated patients had good results.

Adult↗