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Biomedical subjects

G Paone

Publications and source records attributed to G Paone.

At least 73 records · Page 4Linked to original sources
PubMed1991

Surgical treatment of acute myocardial infarction.

In recent years, advances in surgical techniques and perioperative management of cardiac surgical patients have facilitated more aggressive operative treatment of many serious and even catastrophic complications of acute myocardial infarction (MI). In addition, improved understanding of the natural history of these complications has helped to optimize the indications for and timing of surgical intervention. The role of emergency revascularization for postinfarction angina, evolving acute MI, cardiogenic shock after acute MI, and failed percutaneous transluminal angioplasty has expanded with overall satisfactory to excellent results. Surgical treatment of mechanical with overall satisfactory to excellent results. Surgical treatment of mechanical complications of acute MI such as free-wall rupture, acute ischemic mitral insufficiency, and ventricular septal defect also is undertaken earlier and more aggressively. Although the mortality rates for these conditions remain higher than desired, salvage of many previously doomed patients now is a reality.

Acute Disease↗
PubMed1991

[Major surgical complications after 73 consecutive liver transplantations].

In order to evaluate the incidence of postoperative surgical complications requiring additional surgery, we report 73 consecutive liver orthotopic transplantations performed in 60 patients from June 1983 through June 1989. Transplantations were performed in 54 adults and 6 children for the following reasons: postnecrotic cirrhosis in 31, biliary diseases in 16, hepatobiliary malignancy in 7; Wilson's diseases in 3 and fulminant hepatitis in 3. Surgical complications requiring additional surgery occurred in 35 (58%) patients with 53 operations. Twenty-two patients (36%) had postoperative bleeding complications, 5 (8%) biliary complications, one had a late artery thrombosis and 16 (26%) had miscellaneous complications. The latter group included 6 abdominal hernias, 3 bowel perforations, 2 bowel obstructions, 2 cases of pneumothorax, 2 cases of chylous ascitis, one liver necrosis, one hepatic artery kinking, one peritonitis and one cardiac tamponade. The incidence of surgical complications was not significantly different in patients who underwent retransplantation as compared to those who had a single transplantation. We did not find a significant difference in surgical complication rate according to the preoperative liver disease. In comparison with the literature, in our series, we had a higher rate of abdominal hernia but a lower rate of biliary complications.

Adolescent↗
PubMed1990

Technical considerations in aortocoronary bypass grafting.

Since the inception of aortocoronary bypass surgery, many technical advances have been rapidly achieved. Early experience was limited to reversed saphenous vein grafting of single vessel coronary artery disease. Multiple grafts to several vessels soon became commonplace and sequential grafting techniques were developed. Expanded use of the internal mammary artery resulted after analysis of superior patency rates achieved with this conduit. Use of alternative conduits such as upper extremity veins, allogenic veins, synthetic graft material (polytetrafluorethylene), radial artery, splenic artery, and gastroepiploic artery have been explored. Apart from the gastroepiploic vessel, none of these alternative conduits have been suitable. A grat deal of effort has been directed at the mechanisms of saphenous vein occlusion including technical considerations, early thrombosis, intimal hyperplasia and graft atherosclerosis. Platelet inhibition and lipid reduction have shown promise in improving patency rates. Further work in these areas should lead to even better results.

Coronary Artery Bypass↗
PubMed1990

[Malaria prevention: new indications].

Malaria chemoprophylaxis must be continuously modified because of drug-resistant Plasmodium strains. The authors report the most recent regimens in all travelers including infants and pregnant women. The side effects of these drugs are pointed out.

Adult↗
PubMed1989

[Amino acid profile in patients with orthotopic liver transplant].

Plasma amino acids profile is assumed to be a good index of whole body amino acids balance and in particular to give information on the actual control of the transplanted liver on protein metabolism. Variations in plasma amino acids profile were studied in 12 patients undergoing orthotopic liver transplantation. Total parenteral nutrition (TPN) was maintained at 26.05 +/- 1.53 kcal/kg and 0.117 +/- 0.01 gN/kg until the 7th postoperative day. Following this, an enteral nutrition (EN) was added as to maintain a mixed metabolic therapy at 30.28 +/- 2.76 kcal/kg and 0.198 +/- 0.01 gN/kg. Such a treatment completely satisfied the caloric needs, while nitrogen input was prudently kept low in accordance to the lack of data on the metabolic effectiveness of the transplanted liver. Amino acids profiles showed an early metabolic recovery of the new liver. Therefore nitrogen input could be higher and more adequate to nitrogen needs.

Adult↗
PubMed1981

Blood potassium cardioplegia administration. Comparison of myocardial protection offered by three techniques.

To investigate the best method of administration of blood potassium cardioplegia, 19 dogs were studied while undergoing 120 minutes each of aortic crossclamping (myocardial temperature, less than 15 degrees C). Group 1 (six dogs) underwent a single 120-minute period of aortic crossclamping with the heart protected by multiple reinjections (1,000 mL every 30 minutes) of blood potassium cardioplegia solution (potassium chloride, 30 mEq/L; pH, 8; temperature, less than 15 degrees C). Group 2 (six dogs) underwent four separate 30-minute periods of aortic crossclamping, but allowing hearts to beat in a nonworking state for 20 minutes at 35 degrees C between each arrest interval. Hearts in group 3 (seven dogs) were initially arrested as described above, following which a continuous infusion (75 mL/min; KCl, 10 mEq/L) of blood potassium cardioplegia solution was maintained throughout the arrest period. Measurements of myocardial metabolism, ventricular function, regional blood flow, and ultrastructure were carried out before arrest and 30 minutes after final unclamping. Analysis of the data revealed no significant benefit of one method over another, with the exception that adenosine triphosphate level was least preserved with intermittent unclamping and reperfusion. Because continuous perfusion techniques are more cumbersome than multidose reinjection, and intermittent aortic crossclamping lengthens total cardiopulmonary bypass time, we favor the simplest approach, multidose reinjection during a single uninterrupted period of aortic crossclamping.

Adenosine Triphosphate↗
PubMed1981

Ester of 6-cis-dialkylamino-1,3,3-trimethyl-2-oxabicyclo[2.2.2]octan-5-trans-ol with hypotensive and other activities.

Three series of esters of 6-cis-dialkylamino-1,3,3-trimethyl-2-oxabicyclo[2.2.2]octan-5-trans-ol (dialkylamino = pyrrolidino, piperidino, morpholino) are described. A number of these compounds showed strong hypotensive activity in rats, as well as infiltration anesthesia and antiarrhythmic activity in mice. The lowering effects on heart rate in rats are also described.

Anesthetics, Local↗
PubMedDate not supplied

Back-table arterial reconstructions in liver transplantation: single-center experience.

Anatomic variations of the arterial supply to donor liver grafts often require complex hepatic artery reconstructions on the back table. Therefore, because of the additional anastomoses, there is a greater risk of arterial thrombosis and graft loss. Among the 620 orthotopic liver transplantations (OLT) in 549 adult and pediatric patients performed from June 1983 through August 2004, the rates and types of donor hepatic artery variations (HAV) and the type of reconstructions were reviewed as well as the 1- and 5-year grafts and patient survival rates after OLT. At least 1 HAV was present in 133 liver grafts (21.4%). The most frequent variations were as follows: right hepatic artery (RHA) from superior mesenteric artery (SMA) (44 cases); RHA from aorta (4 cases); and RHA from SMA, combined with a left hepatic artery (LHA) from left gastric artery (3 cases). No graft was discarded. Fifty-six of 133 (42%) HAV required arterial reconstructions, generally a termino-terminal (TT) anastomosis between RHA and splenic artery (26 cases, 46.4%). Less frequently performed anastomoses were the "fold-over" technique (15 cases, 26.8%) and the anastomosis between the RHA and the gastro-duodenal artery (6 cases, 10.6%); rare reconstructions were performed in 9 cases (16.0%). The rate of hepatic artery thrombosis was 5.4% (3 of 56 OLT) in complex hepatic artery reconstructions and 2.2% in other grafts. One- and 5-years graft and patient actuarial survival rates have been respectively 73.2%- 71.4% in hepatic artery reconstructions and 78.6%-76.8% in the absence of an artery reconstruction, respectively.

Adult↗
PubMedDate not supplied

[Malignant primary tumors of the liver in childhood].

Twenty-one children (16 males, 5 females) with malignant primary hepatic tumors were admitted to the Pediatric Clinic of the University of Bologna between June 1973 and July 2001. The diagnosis was hepatoblastoma (HBL) in 16 cases; hepatocellular carcinoma (HCA) in 3 cases; undifferentiated sarcoma in 1, malignant rhabdoid tumour of the liver in 1. Median age at diagnosis was 1.8 year (1 mounth-13 years). As to intrahepatic tumor's extension, patients were classified in groups (from I to IV) according to International Society of Pediatric Oncology staging. 2 patients were ascribed to group I; 9 to group II; 9 to group III and I to group IV. At diagnosis 3 pts presented lung metastases. Seventeen patients (81%) were treated with surgery, in 11 cases as first approach to the tumor. In 10 patients, initially with unresesectable tumor, chemotherapy was started first. Drugs used were mostly Cisplatinum or Carboplatinum with Doxorubicin. Sussequently 6 patients were submitted to surgery. At a median follow up of 12.5 years, 52.3% of patients is alive without disease. This percentage rises to 58% taking into consideration only HBL and HCA cases (alive 11/19). We conclude that excluding metastases at diagnosis (3 deaths), the main prognostic factor is resectability and radical surgery: in our experience 4 patients with unresectable tumor died, as 2 patients with microscopical residual after surgery.

Algorithms↗
PubMedDate not supplied

Reduced incidence and severity of accelerated graft atherosclerosis in cardiac transplant recipients treated with prophylactic antilymphocyte globulin.

Allograft coronary artery disease (ACAD) is the major factor limiting long-term survival of cardiac transplant recipients (CTRs). Although cyclosporine based triple drug immunosuppression has not decreased the occurrence of ACAD, some preliminary data suggests that prophylactic antilymphocyte preparations may reduce the incidence of this problem. All CTRs at Henry Ford Hospital have uniformly received prophylactic Minnesota Antilymphocyte Globulin (ALG), thereby providing a unique opportunity to investigate this hypothesis. One hundred three CTRs were followed for a median duration of 34 months with annual angiograms begun one year after transplant. Patients who died without an angiogram were considered to have ACAD based on autopsy results or if their death was clinically suspicious. Ninety-two patients underwent at least one angiogram. Fourteen patients had abnormal angiograms. Nine patients were identified as having ACAD by non-angiographic criteria. Five had autopsy proven disease, 3 died suspiciously, and 1 underwent successful re-transplantation for ACAD. By Kaplan-Meier analysis, the risk of developing ACAD was 12% in 1 year, 16% in 2 years, 22% in 3 years, 26% in 4 years, and 29% in 5 years. Risk of ACAD increased with older recipient's age, higher triglyceride levels, and diabetes, but was not affected by active CMV infection, number of acute rejection episodes, and HLA mismatching. These results suggest that prophylactic ALG reduces the occurrence of ACAD.

Adult↗