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Biomedical subjects

G Bisignani

Publications and source records attributed to G Bisignani.

15 recordsLinked to original sources
PubMed2001

Klippel-Trénaunay syndrome: 2 case reports and a review of genitourinary manifestations.

PURPOSE: We summarize the literature and present our experience with genitourinary manifestations of the Klippel-Trénaunay syndrome, which can lead to challenging management problems. MATERIALS AND METHODS: We report on 2 patients with genitourinary manifestations of the Klippel-Trénaunay syndrome and performed a MEDLINE review of the literature using the key words "Klippel-Trénaunay," "vascular malformation" and "genitourinary." RESULTS: Genitourinary manifestations were cited in 18 articles, including 1,174 cases of the Klippel-Trénaunay syndrome, detailing the presentation and management of bladder, external genitalia and retroperitoneal involvement in the Klippel-Trénaunay syndrome. The overall genitourinary symptoms in patients with the Klippel-Trénaunay syndrome seem to occur in the more severe cases and usually involve cutaneous vascular malformations of the trunk, pelvis and genitalia. CONCLUSIONS: Intra-abdominal and intrapelvic extension of the vascular malformations of the Klippel-Trénaunay syndrome frequently occurs concurrently with the lower abdominal, pelvic cutaneous involvement of the external genitalia, as in our 2 cases and in our review of the literature. These data provide a better understanding of the spectrum of genitourinary manifestations in the Klippel-Trénaunay syndrome and provide insight for the clinician to formulate individual therapies for these patients.

Humans↗
PubMed2000

[The usefulness of the association of clinical probability, rapid plasma measurement of D-dimer, compression echography of the lower limbs and echocardiography in the diagnosis of acute pulmonary embolism].

BACKGROUND: The aim of this study was to investigate the diagnostic utility of clinical probability, rapid plasma D-dimer assay, compression ultrasonography (CUS) and transthoracic echocardiography (TTE) in patients with suspected pulmonary embolism. METHODS: One hundred forty consecutive outpatients with suspected pulmonary embolism were enrolled in a prospective trial. We evaluated sensitivity, specificity, positive and negative predictive value of a combination of clinical probability, D-dimer, CUS and TTE using perfusion lung scan and pulmonary angiography as a combined gold standard for determining the presence or absence of pulmonary embolism. Clinical probability was assessed in accordance with the PIOPED criteria. The D-dimer (Nycocard) level was considered as abnormal > 0.3 mg/l, the CUS if incompressibility of the leg veins was showed, and the TTE if right ventricular dilation was present, in the absence of chronic pulmonary disease. The combination of these tests was considered consistent with the presence of pulmonary embolism if D-dimer plus CUS and/or TTE showed abnormal results. A pulmonary embolism was excluded if D-dimer and CUS showed normal findings or a low clinical probability was associated with normal findings of CUS and TTE. RESULTS: One hundred eleven patients were evaluated. Pulmonary embolism was present in 45/111 (40%) patients. The combination of tests showed positive findings in 39/39 patients with pulmonary embolism, negative findings in 47/50 without pulmonary embolism and non-diagnostic results in 22/111 (20%) patients (95% confidence interval--CI 12-28%). There were three false positive and no false negative results. Sensitivity and specificity were 100 and 94% respectively (95% CI 92-100% and 87-100%); positive and negative predictive values were 93 and 100% (95% CI 85-100% and 93-100%). None of these tests, separately, showed enough sensitivity and specificity. CONCLUSIONS: The combination of clinical probability, D-dimer, CUS and TTE was highly accurate to confirm or rule out pulmonary embolism.

Acute Disease↗
PubMed1999

Successful treatment of right heart thromboemboli with IV recombinant tissue-type plasminogen activator during continuous echocardiographic monitoring: a case series report.

BACKGROUND AND STUDY OBJECTIVE: Echocardiographic detection of right heart thromboemboli (RHTE) during pulmonary embolism (PE) shows an uncommon but life-threatening event. The treatment of this condition is not well established. The aim of our study is to evaluate the efficacy and safety of recombinant tissue-type plasminogen activator (rt-PA) in treating RHTE. METHOD: We performed a transthoracic echocardiogram within (mean +/- SD) 120+/-45 min from onset of symptoms on 30 consecutive patients with proven massive PE. Seven patients (23%) showed RHTE, four patients (57%) had cardiogenic shock; and all patients showed echocardiographic features of acute cor pulmonale. The seven patients with RHTE received an IV infusion of 100 mg rt-PA over a period of 2 h with continuous echocardiographic monitoring. RESULTS: We observed complete RHTE lysis at 45 to 60 min from the onset of rt-PA infusion and significant reductions at 2 h in the following: 14% in right ventricle (RV) end-diastolic diameter (reduction, 40.8 to 35 mm; p < 0.01); 12% in RV/left ventricular ratio (reduction, 0.83 to 0.73; p < 0.01); and 17% in tricuspid regurgitant flow velocity (reduction, 3.5 to 2.9 m/s; p < 0.01). The interventricular septal and RV wall motions improved. An excellent clinical outcome was achieved rapidly in all patients. No adverse events were recorded. CONCLUSIONS: We demonstrated the rapid, effective, and safe action of rt-PA in RHTE resolution and an improvement in pulmonary perfusion. Our data confirm the important role of an early, systematic echocardiographic approach in order to detect RHTE quickly in patients with suspected massive PE.

Aged↗
PubMed1998

[Acute disfunction from thrombosis of a prosthetic mitral valve: thrombolysis with rt-PA in the clinical emergency phase].

Prosthetic valve thrombosis can determine different degrees of valvular insufficiency or obstruction, with a potentially fatal course. The current literature has not established whether the best treatment is thrombolysis or surgery (thrombectomy or valvular replacement). However, both treatments expose the patient to the risk of serious sequelae or death. Here we describe a case of acute thrombosis in a prosthetic mitral valve. At presentation, the patient was in pulmonary edema and had a low cardiac output. She was treated with recombinant tissue-type plasminogen activator infusion (rt-PA 100 mg in 2 hours). Both clinically as well as echocardiographically, we observed a quick regression of the obstruction, but after the treatment, the patient developed an ischemic stroke with aphasia and hemiplegia. The authors conclude that thrombolysis is a highly effective treatment in resolving prosthetic thrombosis. However, because it carries a significant risk of embolization, it should be limited to patients with hemodynamic deterioration in whom surgery could also entail a significant risk of death.

Acute Disease↗
PubMed1997

Voiding cystourethrography after uncomplicated ureteral reimplantation in children: is it necessary?

PURPOSE: Our aim was to assess whether a voiding cystourethrogram after uncomplicated ureteral reimplantation is necessary or cost-efficient. MATERIALS AND METHODS: We retrospectively reviewed the records of patients who underwent uncomplicated reimplantation at our institution from 1988 to 1994. We also reviewed the literature to tabulate the reflux resolution rate from all published series of more than 100 ureters reimplanted. RESULTS: At our institution 119 patients (207 ureters) underwent uncomplicated reimplantation and a postoperative voiding cystourethrogram, which documented a 98.6% initial reflux resolution rate. All persistent postoperative reflux resolved spontaneously without treatment for a final resolution rate of 100%. We reviewed 1,494 abstracts using vesicoureteral reflux as a key word and found 19 series of more than 100 ureters reimplanted. The combined results of our series and those 19 from the literature revealed 3,346 patients (5,008 ureters reimplanted). The final reflux resolution rate was 98.58%. Series that included and excluded secondary vesicoureteral reflux documented final reflux resolution rates of 98.4 and 99.04%, respectively. Reflux resolved spontaneously in 85% of the ureters in which it was noted on the initial postoperative cystogram. At our institution the cost of a voiding cystourethrogram is $610 and we perform an average of approximately 20 uncomplicated reimplantations per year. In the United States there are approximately 230 pediatric urologists. If each surgeon performed 20 reimplantations per year at the same cost per voiding cystourethrogram, a cost savings of $2.8 million per year would result if the study were not performed after surgery. CONCLUSIONS: In the hands of experienced pediatric urologists uncomplicated ureteral reimplantation has a success rate of 99.04%. The yield of postoperative voiding cystourethrography is exceedingly low and a cost savings of $2.8 million per year would result by omitting the postoperative voiding cystourethrogram.

Adolescent↗
PubMed1997

[The role of 2D-doppler electrocardiography in the early diagnosis of massive acute pulmonary embolism and therapeutic monitoring].

Early diagnosis is important for the prognosis of patients affected with pulmonary embolisms. The mortality rate ranges from 30% in untreated cases to 10% in cases getting early treatment. In this context, it is essential to obtain a correct diagnosis in order to start the best treatment for each patient. The aim of our study is to evaluated the contribution of mono- bidimensional echocardiography and color-doppler for the early diagnosis of acute massive pulmonary embolism. We examined 23 patients (14 women with a mean age of 67 +/- 13 years; 9 men with a mean age of 58 +/- 16 years) who were referred to us for observation over a 30-month period. These patients had been admitted to the intensive care unit for suspected acute massive pulmonary embolism and the diagnosis was subsequently confirmed by a pulmonary scintigraphy. None of the 23 patients showed a positive case history of previous heart disease and/or pulmonary disease. The patients were checked using 2D-doppler echocardiography, 120 +/- 45 minutes from the onset of the symptoms. They were then divided into two groups (A and B) based on the presence or absence of thromboembolus in the right cavity of the heart. Seven patients (30%) revealed thromboemboli and were treated effectively with rt-PA (100 mg/2 hours). An increase in the size of the right ventricle with an affected rate RV/LV > 0.6 and the abnormal kinetics of the ventricular septum proved to be the most sensitive parameters for right ventricular overload, as signs of acute massive pulmonary ambolisms were observed in all 23 patients. Tricuspid regurgitation speed (from 2.9 to 3.6 m/sec) and peak systolic pulmonary pressure (67 mmHg) were recorded in all patients. Our observations suggest that the hemodynamic effects of an acute massive pulmonary embolism can be enumerated and monitored by analyzing ventricle size and septum kinetics. To summarize, echocardiography proved to be a simple and realistic test. It enabled correct diagnosis and made it possible not only to start thrombolytic therapy without requiring other exams, but also to monitor and evaluate the effects of this therapy.

Acute Disease↗
PubMed1997

[Long-term captopril therapy in asymptomatic patients with severe chronic aortic insufficiency].

BACKGROUND: Clinical history of patients with severe chronic aortic regurgitation is characterized by a long period without any symptom, although the left ventricle enlarges progressively. The administration of oral vasodilators could reduce ventricular enlargement or its progression, delaying the development of myocardial dysfunction and/or the need for valvular surgery. OBJECTIVES: To verify the efficacy of long-term captopril therapy to reduce left ventricular mass and dimensions in patients with severe chronic aortic regurgitation. METHODS: This is a prospective echocardiographic study in which each individual patient is considered his own control case. Eleven asymptomatic patients with severe chronic aortic regurgitation in sinus rhythm, who had an ejection fraction greater than 50% and were not taking cardiovascular drugs, were orally administered captopril at the maximum tolerated dosage (127 +/- 13 mg/day). Follow-up lasted for 24 +/- 3 months. RESULTS: Left ventricular telediastolic diameter decreased from 69 +/- 5 to 61 +/- 3 mm (p < 0.01), telesystolic diameter decreased from 48 +/- 5 to 41 +/- 4 mm (p < 0.01); ejection fraction increased from 56 +/- 4 to 61 +/- 3% (p < 0.001); myocardial mass decreased from 208 +/- 32 to 174 +/- 27 g/m2 (p < 0.01), and mean wall stress from 264 +/- 35 to 203 +/- 25 mmHg (p < 0.001). All variations were still significant at 6 months. CONCLUSIONS: These results suggest that captopril has a favourable effect on left ventricular mass, dimensions and load conditions, and could favourably influence the natural history of chronic aortic regurgitation. The efficacy of medical treatment can be verified through serial echocardiographic study.

Adult↗
PubMed1993

Echocardiographic features of left ventricular aneurysm and false tendon in a patient with postinfarction pseudoaneurysm after aneurysmectomy.

Three years after the repair of a true left ventricular aneurysm, a 62-year-old man was admitted to our department for spontaneous angina pectoris and heart failure. The two-dimensional echocardiogram revealed a uniformly dilated left ventricle with a large apical aneurysm, in which a thin, continuous, band-like echogenic structure, extending from the interventricular septum to the antero-lateral wall could be visualized. That structure was initially interpreted as a left ventricular false tendon. Color Doppler flow imaging, however, showed a continuous, phasic flow crossing the band-like structure. Thus, the diagnosis of a huge apical pseudoaneurysm was made and subsequently confirmed by angiographic findings. In conclusion, left ventricular pseudoaneurysms may present themselves with unusual morphologic features. In patients with equivocal two-dimensional echocardiographic findings, color Doppler flow imaging is helpful in clarifying morphologic ambiguities and in identifying unsuspected flow abnormalities.

Aneurysm, False↗
PubMed1985

[Arterial hypertension caused by mediastinal paraganglioma. Description of a case and review of the literature].

The Authors describe a case of artery hypertension caused by the secretion from the mediastinal paraganglioma and they emphasize the importance of correct diagnostic approach to patients with hypertension. This particular case is extremely rare, in literature, in fact, there are only 25 known cases of paraganglioma arising from the sympathetic trunk in the posterior mediastinum.

Adult↗
PubMed1981

Effect of bromazepam on growth hormone and prolactin secretion in normal subjects.

The growth hormone and prolactin response to oral bromazepam (3 mg) was assessed in 5 normal men and 5 normal women. A peak growth hormone response of 11.9 +/- 3.7 ng/ml (mean +/- SD), significantly above the baseline (p less than 0.01), was achieved in the men. On the other hand, there was no statistically significant response of growth hormone secretion in the women. No change in prolactin secretion was observed in either sex.

Administration, Oral↗
PubMedDate not supplied

A large left ventricular thrombus evolving towards canalization and mimicking a left ventricular pseudoaneurysm: an echocardiographic study.

We describe a case of a large apical left ventricular thrombus evolving towards canalization and showing echocardiographic features mimicking a left ventricular pseudoaneurysm. Only serial echocardiographic studies allowed an appreciation of the changing morphologic features of the apical structure, permitting differential diagnosis between a canalization of an evolving thrombus and a myocardial free-wall rupture with pseudoaneurysm formation.

Aged↗
PubMedDate not supplied

[Results of a survey on knowledge and habits among hospital doctors concerning primary prevention of venous thromboembolism].

BACKGROUND: The purpose of this study was to analyse the attitudes towards and knowledge of primary prevention of venous thromboembolism (VTE) among hospital doctors in Calabria. METHODS: The survey was based on theoretical knowledge and practical management of hortopedics, surgeons, gynecologists and internists working in 14 hospitals. RESULTS: Out of a total of 340 physicians contacted, 154 (45%) agreed to take part in the survey. 82% of those who responded used VTE prophylaxis on a routine basis. Unfractioned heparin (71%) was the most frequently used methods; early deambulation (55%), low molecular weight heparin (49%) and elastic stocking (49%) were less frequently employed. Surprisingly, one third used aspirin. 75% of those contacted had modified their approach to prevention during the last few years, in particular owing to improvements in pharmacological therapy and increased awareness of the problem. In the survey of clinical practice, 80% of those who took part correctly identified the VTE risk, 86% suggested the best treatment, but only 27% assessed the exact frequency rate of deep venous thrombosis (DVT) and pulmonary embolism (PE) in the absence of prophylaxis. CONCLUSIONS: Most of the doctors contacted showed scant interest in the primary prevention of VTE. The 45% who agreed to be interviewed revealed a good practical approach but were not sufficiently aware of the real incidence of DVT and PE in a clinical risk context without prophylaxis. Although they must be interpreted with caution, these findings allow the real behaviour of hospital physicians in this region to be assessed with regard to the primary prevention of VTE and suggest the need for more correct information about this aspect of venous thromboembolic disease which is not yet sufficiently well known.

Data Collection↗