Fetal cholelithiasis: a prospective study of incidence, predisposing factors, and ultrasonographic and clinical features.
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Cholecystography↗
Biomedical subjects
G Tollis
Publications and source records attributed to G Tollis.
[Biliary lithiasis in childhood. A spectrum of diseases with different clinical significance during fetal life, childhood and adolescence].
On the basis of a research on fetal cholelithiasis, a review on the various form of cholelithiasis in pediatric age has been carried out. These include, in addition to fetal cholelithiasis, lithiasis in the first year of life and lithiasis in infancy and adolescence. These various expressions of the same pathology differ for incidence, predisposing factors, clinical situation, therapy and follow-up. The research conducted on fetal cholelithiasis showed an incidence of 0.39%, higher than expected. There isn't any maternal, obstetrical or fetal predisposing factor. The diagnosis is purely instrumental and is not correlated with known clinical or humoral data. The most frequent evolution is spontaneous resolution of the biliary echogenic images in absence of clinical manifestations; the complications are rare and not well documented. Cholelithiasis in the first years of life is correlated with malformative, pharmacologic or iatrogenic predisposing factors. The clinical situations include symptomless cases with spontaneous resolution and cases with serious complications. Therapy is to be chosen in each case in accordance with clinical features. Pediatric cholelithiasis beyond the first year of life, especially in the later childhood and adolescence, can be similar to cholelithiasis of adults for epidemiology, pathogenesis, symptomatology and therapy.
Adolescent↗
Results of coronary artery bypass grafting by a single surgeon in patients with left ventricular ejection fractions < or = 30%.
Despite the ominous prognosis of severe left ventricular (LV) dysfunction from coronary artery disease, coronary artery bypass grafting (CABG) in this setting remains controversial because of concerns over high operative risk and low likelihood of functional or survival benefit. We analyzed 135 consecutive patients (113 men, 22 women; age 42 to 87 years, mean 66.5) with LV ejection fraction (EF) < or =30% undergoing isolated CABG by 1 surgeon over an 8-year period. LVEF ranged from 10% to 30% (mean 23.6%). Preoperatively, 63% of patients had angina, 61% had heart failure (23% with pulmonary edema), and 24% manifested severe ventricular arrhythmia. The mean number of grafts was 2.7 per patient. The internal mammary artery was used in 103 of the 120 grafts (86%) to the left anterior descending coronary artery. Seven patients (5.2%) died in hospital. Only 2 of 99 patients (2%) not in intensive care preoperatively died in hospital. Angina class improved by 2.0 categories and congestive heart failure class by 1.5 categories. LVEF (assessed in 104 of 128 hospital survivors) improved from 24% preoperatively to 34% postoperatively (p <0.0001). At 1, 3, and 4.5 years respectively, all-cause survival was 87%, 81%, and 71%, and freedom from cardiac death was 90%, 85%, and 80%. CABG in patients with coronary artery disease and advanced LV dysfunction: (1) can be performed relatively safely, (2) achieves good long-term survival, (3) improves LVEF, (4) improves quality of life, and (5) can safely utilize the internal mammary artery as a conduit. The use of CABG is encouraged for patients with advanced LV dysfunction and may provide a viable alternative to transplantation in selected patients.
Adult↗
Prolactin and deficient luteal function.
The possibility of prolactin-dependent subfertility was investigated in a group of 8 women, with luteal insufficiency exhibiting moderately elevated plasma prolactin (PRL) levels and/or galactorrhea. Another group of 10 normal women volunteers served as the control group. A "luteal index" was elaborated by integration of the area below the curve of plasma progesterone (P) values recorded throughout the postovulatory period. The calculated index for normal women was 177 +/- 35 (SD) expressed as [(ng/ml) x time], and the value of 107 (--2 SD) was adopted as the lower limit of normality (97.5% confidence limit). All 8 patients had luteal indexes (range 20--105) below the established limit. Therapy with bromocriptine (CB 154), 5 mg/day, suppressed PRL to normal levels and prolonged the postovulatory hyperthermic phase in 6 out of 8 women. This was accompanied by an improvement in the luteal index, and 5 women conceived. It is concluded that prolactin may interfere with normal progesterone synthesis by the corpus luteum, as demonstrated by the prompt restoration of fertility by bromocriptine treatment in women with regular cycles and inadequate luteal function.
Adult↗