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Biomedical subjects

H D'Agostino

Publications and source records attributed to H D'Agostino.

16 recordsLinked to original sources
PubMed2006

Diaphragmatic rupture: a frequently missed injury in blunt thoracoabdominal trauma patients.

In the US and Western Europe, trauma is the fourth most common cause of death and the leading cause of death in the population less than 45 years of age [Mullinix and Foley, J Comput Assist Tomogr 28(Suppl 1):S20-S27, 2004]. Diaphragmatic injuries occur in 0.8 to 8% of patients after blunt trauma (Gray H, The muscles of the thorax. Anatomy of the human body. Lea & Febiger, Philadelphia, 1918) and may be a predictor of severity of injury in the blunt trauma patient [Worthy et al., Radiology 194(3):885-888, 1995]. The clinical diagnosis of diaphragmatic rupture (DR) is difficult and is missed in anywhere from 7 to 66% of patients [Cantwell, Radiology 238(2):752-753, 2006]. The accurate diagnosis and prognosis of this pathology depend on a complete knowledge of the clinical and radiological presentation. Computed tomography is the imaging modality of choice in the assessment of patients with clinical or radiographic findings suggestive of DR.

Abdominal Injuries↗
PubMed2000

Renovascular hypertension: screening and therapeutic options.

Renovascular hypertension is part of the spectrum of hypertensive disease. Although uncommon (1% to 5% of the cases) in comparison to essential hypertension, it is a potentially curable form of the disease. We review the different tools available for the evaluation and treatment of this condition.

Female↗
PubMed1999

A phase II/pharmacokinetic trial of high-dose progesterone in combination with paclitaxel.

PURPOSE: The purpose of this study was to investigate the effect of high-dose progesterone, an inhibitor of P glycoprotein, on the pharmacokinetics and toxicity of paclitaxel. PATIENTS AND METHODS: A total of 29 patients with various tumors were treated with single-agent paclitaxel (125 mg/m2 administered over 3 h once every 3 weeks) until progression of disease, at which point high-dose progesterone (3 g administered i.v. over 24 h) was added to the paclitaxel treatment program in 20 patients (13 women, 7 men). Pharmacokinetic studies of paclitaxel administered alone and with progesterone were performed in eight patients. RESULTS: The pharmacokinetic parameters of paclitaxel were highly variable. High-dose progesterone increased the peak plasma levels (3.00 +/- 0.94 vs. 4.15 +/- 1.63 microM; P = 0.029; mean +/- SD) and the area under the curve (AUC; 14.3 +/- 4.75 vs. 17.3 +/- 5.59 microM x h; P = 0.006) of paclitaxel. The absolute neutrophil and platelet nadir counts did not differ significantly between the paclitaxel and the combined treatment cycles. Three of the 20 patients documented to have progressive disease on paclitaxel alone had partial responses when high-dose progesterone was added to the paclitaxel regimen. CONCLUSION: Progesterone had a statistically significant impact on the pharmacokinetics of paclitaxel. The addition of high-dose progesterone to paclitaxel is feasible, but the small number of patients prevents conclusions being drawn about the clinical efficacy of combined progesterone and paclitaxel.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1999

Holmium laser lithotripsy of a complicated biliary calculus.

More than 500,000 cholecystectomies are performed annually. Extracorporeal shockwave lithotripsy and endoscopic laser lithotripsy have been used for the management of common bile duct calculi, which complicate 10% of cases. We report the first successful clinical application of the Ho:YAG laser to a complex biliary calculus case.

Aged↗
PubMed1994

Treatment of postbiopsy pneumothorax with a self-contained pneumothorax treatment device.

PURPOSE: To evaluate the usefulness of a self-contained pneumothorax treatment device, in which a catheter and a one-way valve compose a single unit, in cases of postbiopsy pneumothorax. MATERIALS AND METHODS: Twenty-one patients underwent placement of the device to drain a postbiopsy pneumothorax. Treatment was considered successful when no therapy other than the device was needed. RESULTS: Treatment was successful in 16 (76%) of the 21 patients. Causes of treatment failure were dislodgment of the device (n = 3), malfunction of the device (n = 1), and a persistent air leak that led to pneumothorax recurrence after removal of the device (n = 1). Eight patients (38%) experienced problems after insertion of the device: The device dislodged in seven patients and malfunctioned in one patient. These problems led to treatment failure in four patients (see above). In the remaining four, further treatment after device dislodgment was not required. CONCLUSION: Treatment with the self-contained pneumothorax treatment device shows promise. Modifications to the device may alleviate technical problems and insertion difficulties.

Aged↗
PubMed1993

CT-guided celiac ganglion block with alcohol.

Celiac ganglion block has been performed without radiologic guidance by surgeons or anesthetists since it was first described by Kappis [1] in 1914. Radiographic guidance for celiac block was first reported in the 1950s [2], and more recently, radiologists have used CT to guide needle placement [3-5]. With CT guidance, more directed positioning of the needle is possible, allowing alcohol to be deposited in the specific ganglion areas. This article reviews our collective experience with CT-guided celiac ganglion block.

Autonomic Nerve Block↗
PubMed1992

Laparoscopic injuries to the bile duct. A cause for concern.

The authors report six patients who had injuries to their common hepatic bile duct at laparoscopic cholecystectomy over a 16-month period. Five of the six complications could be attributed to laser injuries during dissection in the region of Calot's triangle. The authors discuss the possible mechanism of these injuries, their perioperative management, and the methods of surgical reconstruction. The follow-up period ranges from 3 months to 21 months. Liver function parameters and isotope biliary excretion scans are back to normal in all six patients. The potential hazards of laparoscopic surgery demand that extraordinary care be used not only during the actual surgical procedure, but also in the preoperative decision concerning the dissection method to be employed.

Adult↗
PubMed1991

Interventional radiology in gallstone disease.

Interventional radiologic techniques for the treatment of gallstone disease are becoming more widely available. Percutaneous cholecystostomy [corrected] can be lifesaving in critically ill elderly patients who have acute cholecystitis. Contact dissolution of stones with methyl tert-butyl ether and percutaneous extraction (with or without fragmentation) of calculi are treatment options in patients who are at high risk for surgery or who do not desire an operation. With increasing use of intracorporeal gallstone lithotripsy techniques in the gallbladder and bile ducts, combined fluoroscopic and direct visualization during percutaneous procedures is becoming more important. Percutaneous chemical ablation of the gallbladder offers a potential solution to the problem of gallstone recurrence.

Acute Disease↗
PubMed1991

Techniques and clinical utility for percutaneous cholecystostomy.

Therapeutic gallbladder procedures offer new options for treatment of gallbladder disease. These procedures may be life-saving, may be easier than other available techniques, or may merely provide an alternative form of therapy. Further use of these techniques will likely result in improvements in PC, as well as providing an ongoing definition of the role of these percutaneous procedures.

Cholangiography↗
PubMed1990

Interventional gallbladder procedures.

Interventional radiologic procedures in the gallbladder are influencing both the diagnosis and therapy of many gallbladder disorders. Current diagnostic and therapeutic percutaneous techniques offer important alternatives for their management. This article highlights the spectrum of interventional radiologic techniques available for gallbladder diseases.

Biopsy, Needle↗
PubMed1980

Ligation of the pancreatic duct in pancreatectomy.

This study was undertaken to determine the safety of duct ligation in pancreatic surgery. Duct ligation was performed in 43 patients after pancreaticoduodenectomy and in 108 patients after distal pancreatectomy; 33 patients had a pancreaticojejunostomy after a pancreaticoduodenectomy. All procedures were performed between 1965 and 1975; the analysis was retrospective. The mortality and morbidity for the duct ligation group after pancreaticoduodenectomy were 19 per cent and 77 per cent and after distal pancreatectomy were 4 per cent and 9 per cent respectively. After pancreaticoduodenectomy with pancreaticojejunostomy the mortality was 18 per cent with a morbidity of 33 per cent. It is concluded that distal pancreatectomy with duct ligation is a relatively safe procedure, while after pancreaticoduodenectomy the morbidity is significantly reduced (P less than 0.001) by a pancreaticojejunostomy.

Duodenum↗
PubMed1980

Histologically positive esophageal margin in the surgical treatment of gastric cancer.

Histologically positive esophageal margins caused by transection of the esophagus in an area involved by disease were encountered in 20 percent of 350 patients undergoing total or proximal subtotal gastrectomy for gastric cancer. There was a significant increase in the incidence of positive margins in patients with neoplasms of the cardia and in those who were managed without frozen-section examination of the resected esophagus. Positive margins were avoided only with resection of 12 cm or more of macroscopically tumor-free esophagus above the primary. Despite the presence of tumor at the margin, anastomotic recurrences appeared in only 23 percent of the patients at risk. Recurrences affected mainly those who had TNM stage I and II lesions. Patients with more advanced disease usually died from metastasis without developing anastomotic recurrence. Positive margins were associated with a poor prognosis that was not influenced by adjuvant postoperative treatment. The avoidance of positive margins by wide esophagectomy is important in patients with TNM stage I and II disease, particularly if the primary lesion is located in the cardia. Patients with positive margins should be watched closely rather than subjected to further treatment.

Adenocarcinoma↗
PubMedDate not supplied

[A comparative multicenter study of the efficacy of single- and double-lumen catheter drainage].

Our study was aimed at comparing the therapeutic efficiency of single and double lumen catheters in the drainage of abdominal fluid collections. We report the results of in vitro and in vivo studies carried out to assess the usefulness of each catheter type based on its therapeutic results. In the in vitro study the aspiration efficacy of the catheters was tested in a simulated cavity. In the in vivo study 188 patients with 206 fluid collections in the abdomen were examined; the patients had been treated percutaneously with single or double lumen catheters, randomly. In each patient we studied drainage efficiency related to aspiration efficacy, the time the catheter rested in the cavity, patient's discomfort and finally the cost of both the device and hospitalization. Some patients underwent surgery for specific reasons, but nevertheless their clinical conditions were absolutely improved thanks to percutaneous drainage. The results of this study yield useful clinical data to choose the most suitable catheter for the percutaneous treatment of abdominal fluid collections. Single lumen catheters work better than double lumen ones, the latter being also more expensive. Hospitalization time is also reduced when single lumen catheters are used.

Adolescent↗