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Biomedical subjects

G Melloni

Publications and source records attributed to G Melloni.

33 records · Page 2Linked to original sources
PubMed1994

Self-expanding stents in the treatment of tracheobronchial obstruction.

The self-expandable stainless steel stents (Gianturco, William Cook, Bjaeverskov, Denmark) used extensively in biliary ducts and the vascular system have recently been modified for use in the tracheobronchial tree. Between March 1991 and September 1992, six patients with unresectable tracheobronchial and mediastinal diseases were treated with the placement of one or more self-expanding stents under direct vision with a fiberoptic bronchoscope. All patients had been intubated for severe respiratory insufficiency. In all cases, immediate relief of respiratory symptoms was achieved and all patients were extubated 1 or 2 days after stent placement. Tolerance of the stents was excellent. No patient complained of pain, discomfort, or foreign body sensation. No infection or obstruction of the stents was observed. The chest roentgenogram and the bronchoscopies performed during follow-up have shown no change in the position of the stents. Our results seem promising since these devices provide effective palliation of airway obstructions and are well tolerated.

Adult↗
PubMed1993

[Cardiorespiratory changes induced in man by the acute occlusion of the main bronchus].

Following the exclusion of the ventilation of a lung, perfusion is arrested as a consequence of the Von Euler and Liljestrand vasoconstrictive reflex. However it is as yet unknown how long this phenomenon takes to manifest itself in human beings. In order to verify whether hypoxic pulmonary vasoconstriction follows immediately on the arrest of ventilation or whether there is one some delay, in 21 candidates for pneumonectomy a bronchial block was provoked during fibrobronchoscopy and the hemogasanalytic modifications induced by the acute occlusion of the main bronchus have been studied. The analysis of the resulting data allows for the hypothesis that the exclusion of lung ventilation for 14 minutes is not sufficient to cause the complete manifestation of the hypoxic vasoconstrictive reflex.

Aged↗
PubMed1993

[Endoscopic monitoring in lung transplantation. Transplantation Group of the Maggiore Policlinico Hospital of Milan].

During the period March 1991-June 1992 5 single lung transplantations were successfully performed at the Ospedale Maggiore Policlinico in Milan. All patients underwent regular fibrobronchoscopies within the context of a complex follow-up programme in order to monitor the resolution of the bronchial anastomosis and identify the onset of intercurrent lung infections and rejections using bronchioalveolar lavage (BAL) and transbronchial biopsies (TBB). Forty-four fibrobronchoscopies were performed of which 24 for anastomotic follow-up, BAL and TBB, and 20 for the simple monitoring of the anastomosis. Fibrobronchoscopies confirmed the optimal resolution of bronchial anastomosis in 4 patients, whereas one patient showed a granulomatous anastomotic reaction which was successfully treated using local steroid injections. Although recovery was normal in one patient, kinking appeared in the bronchus of the receiving lung which was successfully treated by the insertion of Gianturco prosthesis. BAL enabled the identification of 2 CMV infections, one Pseudomonas aeruginosa, one Haemophilus influenzae and one Pneumocystis carinii infection. TBB allowed 3 cases of CMW lung infection and 7 episodes of rejection to be diagnosed. The authors' personal experience confirms the decisive role played by bronchoscopy in the follow-up of lung transplant patients. This procedure allowed bronchial anastomosis to be closely monitored and was of vital importance in the diagnosis of lung infections and rejection.

Adult↗
PubMed1992

[Endoscopic laser therapy in the palliative treatment of cancer of the esophagus].

Frequently when dysphagia first becomes manifest, esophageal carcinoma is already unresectable. Endoscopic laser therapy is a recently introduced method which can be used for the palliative treatment of esophageal cancer. By using the method the tumour is destroyed and the esophagus is recanalized, there is low incidence of complications, and the patient can be fed naturally thus improving quality of life. The method has been perfected over the past years and now offers excellent results.

Esophageal Neoplasms↗
PubMed1990

[Transection of the popliteal artery caused by exostosis].

Two cases of post-traumatic transection of the popliteal artery in patients with exostosis of the lower extremities are reported. This complication does not seem to have been previously described in the literature. The pathogenetic, clinical, diagnostic and therapeutic aspects are analysed.

Accidents, Traffic↗
PubMedDate not supplied

[Percutaneous or surgical trachetomy. Prospective, randomized comparison of the incidence of early and late complications].

BACKGROUND: To compare early and late complications after either conventional surgical or percutaneous dilatational tracheostomy. DESIGN: Prospective, randomized study. SETTING: General intensive care unit and neuro-surgical intensive care unit in a university hospital. PATIENTS: 50 consecutive patients, requiring tracheostomy for prolonged mechanical ventilation. INTERVENTIONS AND MEASUREMENTS: Patients were randomly allocated to receive either surgical (surgical group, n = 25) or percutaneous dilatational tracheostomy (percutaneous group, n = 25). Occurrence of perioperative complication were carefully evaluated during ICU stay. Late complications were evaluated with both physical and endoscopic examination at 1, 3 to 6 months after tracheostomy. RESULTS: All surgical and percutaneous tracheostomies were successfully completed and no deaths directly related to the tracheostomy procedures were reported. Completion of the procedure required 41 +/- 14 min in the surgical group and 14 +/- 6 min in the percutaneous one (p < 0.0001). The incidence of early perioperative complications was higher in the surgical group (36%) than in percutaneous one (12%), (p < 0.05). The endoscopic follow-up demonstrated one segmental malacia and one stenosis of the trachea in the percutaneous group only (p = n.s.). Skin repair was better after percutaneous tracheostomy than in the surgical group (p < 0.01). CONCLUSIONS: In experienced hands, percutaneous dilatational tracheostomy is as safe and effective as the conventional surgical tracheostomy. The percutaneous technique is less time-consuming and has a lower rate of early infectious complications with better cosmetic results than the surgical technique.

Female↗
PubMedDate not supplied

Single lung transplantation for emphysema. Lessons learned on the field. The Lung Transplant Group of the Ospedale Maggiore of Milan.

Emphysematous patients that were once treated with double lung transplantation can now also be treated with single lung transplantation. However, single lung transplantation in emphysematous patients presents problems in lung size matching, choice of side to transplant and post-operative assistance. Analysing their own experience of three single lung transplants performed on emphysematous patients, the Authors evaluate the effectiveness of the operation, the results and the difficulties encountered. Single lung transplantation is a good therapeutic option for end-stage emphysematous patients. In these patients right lung transplantation is preferable and the donor organ should be oversized. Positive and expiratory pressure in the native emphysematous lung should be applied with extreme caution.

Adult↗
PubMedDate not supplied

[Lung transplantation: a clinical reality].

Lung transplant has now become a viable clinical option for the treatment of irreversible end-stage respiratory failures. The first successful single lung transplant was performed by Cooper and coworkers in Canada in 1983, and the first successful double lung transplant was performed by the same group in 1986. The history of lung transplantation is followed by a discussion of the current surgical indications for single and double lung transplants. The criteria for the evaluation and pre-operative management of potential candidates are reported. The surgical techniques used for harvesting, preserving and transplanting one or both lungs are then described, including the latest procedure of sequential bilateral lung transplantation. Almost 250 patients have undergone single or double lung transplants all over the world with a survival rate of more than 65%. Lung function and exercise tolerance have satisfactorily improved. Despite a number of problems in airway anastomosis and in diagnosis and treating rejection still to be resolved, lung transplantation is rapidly gaining ground worldwide.

Graft Rejection↗
PubMedDate not supplied

Efficacy of ketorolac tromethamine and extrapleural intercostal nerve block on post-thoracotomy pain. A prospective, randomized study.

BACKGROUND: Post-thoracotomy pain causes severe impairment of the respiratory function. Epidural analgesia is effective in the treatment of post-thoracotomy pain but may give rise to significant side-effects. Other low-risk and cost-effective analgesic treatments are therefore required. METHODS: Thirty male patients who had undergone pulmonary lobectomy entered a prospective, randomized trial to evaluate the efficacy of ketorolac tromethamine (Group 2) and extrapleural intercostal nerve block (Group 3) with intermittent low-dose bupivacaine. Objective and subjective assessment was carried out at 8, 16, 24 and 48 hours postoperatively. RESULTS: There were no significant differences between Groups 1 (control group) and 2. Vital capacity was significantly lower in Group 3 (p<0.05) than in Group 1 after 16 hours. Forced Vital Capacity was significantly higher in Group 2 than in Group 3 after 16 and 24 hours (p<0.05). Peak expiratory flow was also significantly better in Group 2 than in Group 3 after 16 hours (p<0.05). On-demand opioid consumption was significantly lower in Group 2 (p<0.001) and Group 3 (p<0.05). No side-effects were observed. CONCLUSIONS: Ketorolac tromethamine was effective in the treatment of post-thoracotomy pain. Extrapleural intercostal nerve block allowed a significant reduction in the consumption of opioids. These analgesic techniques could be useful as low-risk, cost-effective and reproducible treatments when more effective techniques, such as epidural analgesia, are contraindicated.

Aged↗
PubMedDate not supplied

Temporary main bronchial occlusion under bronchoscopic control in the evaluation of candidates for pneumonectomy.

BACKGROUND: In this study we report our experience with temporary main bronchial occlusion in the preoperative evaluation of candidates for pneumonectomy. METHODS: Between January 1991 and January 1994, 57 candidates for pneumonectomy underwent a 15-minute temporary main bronchial occlusion with an inflatable balloon during fiberoptic bronchoscopy. The following parameters were monitored during bronchial occlusion: general status, ECG, arterial pressure, heart rate and respiratory rate. Arterial blood gases were measured after 7 and 14 minutes. Values at 7 and at 14 minutes were compared with those obtained before the procedure. Patients were considered suitable surgical candidates for pneumonectomy if PaCO2 < 42 mmHg and pH > 7.35. RESULTS: Fifty-three patients were considered functionally operable. Three patients were considered functionally inoperable (PaCO2 > 42 mmHg, pH < 7.35 and appearance of dyspnea). One patient was excluded from the analysis because of balloon mispositioning due to a coughing fit. Sixteen of the operable patients underwent pneumonectomy and all did well without clinical evidence of respiratory insufficiency. At present 11 patients are alive, all without chronic respiratory insufficiency (mean follow-up 14 months). No postoperative mortality related to cardiorespiratory problems was observed. CONCLUSIONS: Temporary main bronchial occlusion is a simple and inexpensive test that can correctly predict functional resectability in candidates for pneumonectomy.

Adult↗
PubMedDate not supplied

Surgical treatment of non-small cell lung cancer in patients 70 years of age or older.

BACKGROUND: Indications to surgical treatment of lung cancer in the elderly are still being discussed. The aim of this study was to evaluate postoperative complications and survival after surgery for non-small cell lung cancer (NSCLC) in patients 70 years of age or older. METHODS: During a 4 year and 6 month period, 76 patients (67 men and 9 women) entered the study. RESULTS: Postoperative complications occurred in 15 cases (19.7%) and the 30-day operative mortality was 1.3%. The overall 54 month actuarial survival was 53%. Mortality at 12 months wasn't related to stage of disease, histology or lobectomy versus wedge resection but was higher in those patients who had had postoperative cardiopulmonary complications. Results of preoperative spirometry, blood gas and cardiac status were predictive of mortality at twelve months (p < 0.05). CONCLUSIONS: Surgery for NSCLC in the elderly should not be denied on the basis of age alone. Postoperative outcome is mainly related to concomitant cardiopulmonary disease.

Aged↗