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Biomedical subjects

L Pedrini

Publications and source records attributed to L Pedrini.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

[Census of the Italian Nephrology and Dialysis Units. Comparison between Lombardy and Piedmont].

The Italian Society of Nephrology promoted a national survey to obtain detailed information from all the Renal and/or Dialysis Units through an on-line questionnaire concerning structural, technological and human resources, as well as organisation characteristics and activities. The purpose of this initiative was to obtain regional reference benchmarks for each Nephrology Unit. In this paper we compare two northwestern Italian Regions: Lombardy and Piedmont. As far as epidemiology is concerned, the prevalence of dialysis patients is quite similar in the two Regions: for haemodialysis 616 pmp (patients per million population) in Lombardy and 595 in Piedmont, for peritoneal dialysis 104 pmp vs. 114 pmp, while the incidence of dialysis patients is 169 vs. 166 pmp. The gross mortality for dialysis patients is 12.4% vs. 13.7% and 0.9% vs. 2.0% in transplanted patients. The distribution of vascular access is also quite similar in the two Regions: prevalent arteriovenous fistula 83% vs. 74%, central venous catheter 11% vs. 18%, vascular grafts 7% vs. 8%. Structural resources: the hospital beds (49 pmp in the two Regions) and the dialysis places (161 vs. 166 pmp) do not differ between the two Regions. Personnel resources: physicians 37 pmp in Lombardy and 44 pmp in Piedmont, renal nurses 167 pmp vs. 186, respectively. Activity: hospital admission 1722 pmp vs. 1507 pmp, renal biopsies 131 pmp vs. 109 pmp. Although the two regions examined are numerically different, both have a high standard of quality, making Italy a model of nephrology organisation. This initiative to take a census of the Italian Nephrology and Dialysis Units provides an interesting tool to describe the present status of the operational structures, to identify precise benchmarking values, at both the regional and national level, and to act as a prelude for further rationalization and growth of the nephrology network in Italy.

Ambulatory Care Facilities↗
PubMedDate not supplied

Morbidity and mortality following carotid surgery.

The records of 920 patients who underwent carotid endarterectomy by the same surgeon (M. D'A) between 1976 and 1989 were reviewed. Particular attention was paid to both the neurological and general complications and to how and when the neurological symptoms appeared. Among these patients, a cumulative stroke plus death rate of 3.1% was observed. Complications were classified as clamping ischemia (2.2%), postoperative embolism (1.5%), postoperative thrombosis (2.4%), and cerebral haemorrhage (0.3%). Two patients (0.2%) died from myocardial infarction. In 3.5% of patients, neurological symptoms were transient. The incidence of clamping ischemia was higher when 40 mmHg was considered as the safety limit of the back-pressure; this incidence fell by raising this limit to 50 mmHg, and introducing, in recent years, SEPs monitoring. Intraoperative monitoring of SEPs, in fact, reduced the neurological complications to 1.4%, while intraoperative angiography reduced the need for intraoperative reoperation from 10% to 2%. The use of antiplatelet drugs and an accurate surgical technique are useful steps in the prevention of postoperative embolism or thrombosis.

Cerebrovascular Disorders↗
PubMedDate not supplied

Carotid endarterectomy in young adults.

The results of carotid endarterectomy in 521 patients were analyzed to verify whether the early and late outcome in young patients is worse than in older patients, such as the results observed in peripheral arterial reconstruction in young adults. The patients were subdivided into 3 groups: 105 under 55 years, 397 aged between 56 and 74 years and 19 over 75 years. Young patients presented less risk factors and associated diseases than older ones, with the exception of smoking-habit; on the other hand, they presented a higher incidence of early post-operative thrombosis, myocardial infarction and of recurrent stenosis at follow-up. This trend has already been observed in other series. Young age and smoking habit have also been significantly related with recurrent carotid stenosis. In spite of these complications, carotid endarterectomy is indicated in severe stenosis or complicated carotid plaques, in young adults, because of a low operative mortality and a better trend in the follow-up period; however, the pre-operative evaluation needs a more accurate study and, when possible, the normalization of metabolic risk factors and the elimination of smoking.

Adult↗
PubMedDate not supplied

Iatrogenic vascular lesions. Pathogenesis and treatment: an 18 year review.

The records of 304 patients operated on for vascular injuries were reviewed; 76 (25%) of these presented an iatrogenic vascular injury: 13 involved the upper limbs, 49 the lower limbs and 14 the neck and trunk. The lesions were due to a vascular catheterism in 40 patients, to orthopaedic treatment in 27 patients, to general surgery procedure in 3 patients, to urologic surgery in 3 and to otorhinolaryngologic surgery in 3. In vascular catheterism the prevalent complications were thromboses and embolisms; 3 patients needed an amputation after the surgical repair. In orthopaedic surgery, vascular complications were linked prevalently to hip surgery, exchange arthroplasty and upper tibial osteotomy. In urologic, otorhinolaryngologic and general surgery, vascular lesions were prevalently related to haemorrhagic complications, followed by incorrect haemostatic manoeuvres. Retroperitoneal fibrosis or previous surgery increased the risk of vascular injuries. Delay in treatment was responsible for post-operative death or incomplete recovery.

Catheterization, Peripheral↗
PubMedDate not supplied

Inflammatory aspects in atherosclerotic abdominal aortic aneurysms. A case report.

An important inflammatory reaction was histologically observed in the wall of an abdominal aortic aneurysm in a 42 year-old patient suffering from multifocal atherosclerotic lesions. Histochemical and ultrastructural studies showed an active-stage wall lymphomonoplasmacellular component. The histological appearance and biochemical and microbiological studies excluded specific aortitis, a rheumatic disease or concomitant infectious processes. The morphological relationships between the atherosclerotic lesion and the infiltrate together with the immunophenotyping features of the infiltrate suggest the possibility of a close correlation between the inflammatory process and the atherosclerotic lesion of the wall.

Adult↗
PubMedDate not supplied

Carotid endarterectomy. Pre- and post-operative monitoring with cerebral SPECT.

In the pre-operative evaluation of carotid endarterectomy, the knowledge of ischemic areas may be helpful to reduce the operative risk. A positive CT scan is often correlated with an increased operative risk. The single photon emission computed tomography (SPECT) allows us to visualize ischemic areas not shown by the CT; these areas are almost always correlated to neurological symptomatology. In patients with positive CT scan, the ischemic areas shown by SPECT are generally larger, because this technique visualize the ischemic area surrounding the cerebral infarct (penumbra). After carotid EA, SPECT is useful to show the hemodynamic modifications induced by this operation. In a series of 15 patients we observed an improvement of the cerebral blood perfusion characterized by the normalization of the blood flow in 7/12 (58%) of the ischemic areas observed pre-operatively), an improvement in 3/12 and a normalization or an improvement in the contralateral hemisphere in 5/7 of the areas. In conclusion SPECT is a useful technique to study the cerebral pathophysiology of both cerebrovascular disease and its surgical treatment.

Aged↗
PubMedDate not supplied

Intermittent ischemia caused by dissection of the abdominal aorta through myxoid degeneration. Case report.

Acute intermittent ischemia is generally caused by altered vasomotion and rarely by aortic dissection. There is reported a case of dissection of the abdominal aorta which presented a mixoid degeneration of the inner wall. The surgical finding was similar to a medio intimal aortic cylinder obtained generally during endarterectomy. Five years after the operation (endarterectomy of the mixoid cylinder) the patient presents a good patency of the aortoiliac area.

Aortic Dissection↗