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Biomedical subjects

L Roncoroni

Publications and source records attributed to L Roncoroni.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

Cardiovascular effects of AR-L115 BS in conscious dogs with and without chronic congestive heart failure.

AR-L115 BS is a phenyl-imidazo-pyridine derivative that combines positive inotropic and vasodilator properties. To analyze the mechanisms of action of AR-L115 in the presence or absence of heart failure, we administered it intravenously to conscious dogs (seven normals and eight with a volume-overload heart failure). In normals, at a plasma level around 1,000 ng/ml, AR-L115 BS increased left ventricular (LV) peak (+) dP/dt (+48%; p less than 0.02) and heart rate (+29 beats/min; p less than 0.05) without altering significantly cardiac filling pressures or cardiac output. The mean aortic pressure and the systemic vascular resistances (-20%; p less than 0.02) were reduced, but plasma renin activity (PRA) was unchanged. In heart failure, the same plasma level increased peak (+) dP/dt by 36% (p less than 0.01), but heart rate stayed unchanged. Mean aortic pressure, systemic vascular resistances (-20%; p less than 0.01), and LV end-diastolic pressure (-9.1 mm Hg; p less than 0.01) all dropped significantly, while cardiac output increased slightly; PRA did not rise significantly. After beta-blockade, the increases in peak (+) dP/dt and the changes in systemic vascular resistances were markedly reduced. In conclusion, AR-L115 BS has strong positive inotropic and vasodilator effects, both of which are partially dependent on the level of the sympathetic tone in the intact animal. These combined properties improve hemodynamics in heart failure; this improvement is already significant at relatively low plasma levels, at which deleterious changes in heart rate or PRA are absent.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Long term follow-up after radical mastectomy for breast cancer (author's transl)].

110 of 126 patients treated with Halsted mastectomy and postoperative loco-regional radiotherapy, during period 1961-1969 have been controlled. Overall 5 years survival resulted as following: Columbia Clinical Classification stage A 90,6%, stage B 66,6%, stage C 28,5%, stage D 33,3%; 10 years survival in patients operated on in the period 1961-64 was: stage A 69,2%, stage B 53,3%, stage C 40%, stage D 0%. On the basis of the satisfing results obtained the authors conclude that it appears by now unjustified to modify this method in treating stage A and B breast cancer either utilizing less extended resections, or renoncing to the postoperative irradiation.

Breast Neoplasms↗
PubMedDate not supplied

[Correlation between histological findings and clinical behavior following surgery for portal hypertension in cirrhosis (author's transl)].

This is a retrospective study of 29 cirrhotic patients who underwent surgery for haemorrhage or ascites due to portal hypertension, carried out to look for any correlation between histological findings and clinical outcome. When Mallory's bodies and signs of activation are found, indicating that the cirrhosis is progressing, the clinical results are often discouraging. A careful choice of which cirrhosis patients are likely to gain from surgery should take account of selective histological criteria as well as full clinical and haemodynamic data.

Adult↗
PubMedDate not supplied

Diverticulitis of the caecum and ascending colon: an unavoidable diagnostic pitfall?

PURPOSE: The infrequency of right-sided colonic diverticulitis prompted this presentation of our experiences, with emphasis on the diagnostic aspects. PATIENTS AND METHODS: Charts and documentation regarding 20 patients who underwent surgery for diverticulitis of the caecum and/or ascending colon over 22 years were reviewed. RESULTS: Eleven patients underwent pre-operative instrumental examinations: right-sided diverticulitis was recognized in five patients (two by barium enema, two by both ultrasonography and computerized tomography, one by all three examinations) and was suspected in another four. All diagnoses on merely clinical grounds--acute appendicitis in 10 patients and perforated peptic ulcer in one--were erroneous. Surgery consisted of 13 right standard or limited hemicolectomies, six conservative procedures and one Mickulicz' operation and subsequent right hemicolectomy. No operative deaths or long-term failures were reported. CONCLUSIONS: In the presence of clinical features atypical of acute appendicitis, right-sided colonic diverticulitis should be taken into account; pre-operative instrumental examinations might increase diagnostic accuracy, thereby leading to a more correct therapeutic approach.

Adult↗
PubMedDate not supplied

[Interposition meso-caval shunt for haemorrhage or ascites in hepatic cirrhosis. Report of twenty-eight cases (author's transl)].

The results are set out of emergency or electiver surgery for bleeding oesophageal carices or for intractable ascites in hepatic cirrhosis. The procedure adopted, a meso-caval shunt with prothesis interposition, led to a low percentage of thrombosis, markedly lowered portal pressure, and gave effective clinical results. Although angiography indicated that the portal flow to the liver had dropped considerably, or even ceased altogether, the bad effect on liver function and the incidence of encephalopathy seemed reduced than generally reported after porta-cava shunts. No deaths occurred among the patients for who surgery had been planned, but the rate was still high in emergency cases. This indicates that although well tolerated, the interposition meso-cava shunt is best performed after careful pre-operative selection and preparation.

Adult↗
PubMedDate not supplied

[Present position of non-shunt surgery for bleeding oesophageal varices (author's transl)].

This is a critical retrospective study of a homogeneous group of 24 patients with hepatic cirrhosis and portal hypertension who underwent emergency surgery for bleeding oesophageal varices. The adopted procedure was the porta-azygos disconnection, according to Torres-Degni, with or without splenectomy. The criterion derived from the need to stop bleeding, from contraindications to a portal-systemic shunt, or from other situations which are illustrated. The difficulty of selecting in these cases the appropriate surgery and the high operative death rate (46%) is commented. In survivors, the long-term outcome depends on the progress of the underlying liver disease.

Adult↗
PubMedDate not supplied

[Dissection-ligation of the oesophagus according to Vosschulte for bleeding varices (author's transl)].

Ligation of the oesophagus on a Vossschulte prosthesis provides interruption of the venous back-flow in gastro-oesophageal wall occurring in portal hypertension, and therefore renders more effective the disconnection techniques used for oesophageal varices when liver function is too severely impaired to permit a portal-systemic shunt. According the literature and their own initial experience, the Authors stresse the possibilities of the method in controlling active haemorrhage and preventing further bleeding, and discusse its possible complications, represented by portal thrombosis, fistulae and oesophageal stenosis. Unlike shunts, this procedure does not give rise to any worsening in hepatic function, but should nevertheless seriously considered especially if the oesophago-gastric junction is radically isolated.

Adult↗
PubMedDate not supplied

[Further comments on changes in hepatic function after interposition meso-caval shunt (author's transl)].

Further to a previous paper, the Authors followed up ten cirrhotic patients who had all undergone meso-caval shunt with Dacron prosthesis, for ascites or haemorrhage, Functional and anzymatic investigations were carried on over periods up to 10 months. No constant changes in hepatic function parameters were found during the post-operative period, compared to those before surgery. This observation suggests that these investigations might be more useful in defining liver disease than in practical assessment of transient, post-operative liver failure.

Adult↗
PubMedDate not supplied

[Videolaparoscopy and carcinoma of the gallbladder].

There have been several reports claiming that there is a risk that laparoscopic cholecystectomy might worsen the prognosis of unexpected gallbladder cancer. The objective of this study was to evaluate which factors influence the prognosis of such cancers. A clinicopathological study was conducted in 25 patients with unexpected gallbladder cancer. The results of 10 patients undergoing laparoscopic cholecystectomy were compared with those of 15 patients undergoing open cholecystectomy. Correlations were evaluated between cumulative survival rates and seven prognostic factors, namely, age, sex, histopathological grade, pathological stage, occurrence of bile spillage, type of cholecystectomy (laparoscopic or open) and additional surgical treatments. Seven patients after laparoscopic cholecystectomy (70%) and 9 patients after open cholecystectomy (64%) had cancer recurrence: the difference was not statistically significant. There was a statistically significant correlation between survival rate and tumour stage (P < 0.01) and occurrence of bile spillage (P < 0.05). There was no difference in survival depending on whether cholecystectomy was carried out using laparoscopic or traditional techniques. Laparoscopic cholecystectomy does not adversely affect the prognosis of unexpected gallbladder cancer. Once the histological findings have been examined, the surgeon will decide whether it is necessary to extend surgery, regardless of whether laparoscopic or open cholecystectomy is carried out.

Adult↗
PubMedDate not supplied

[Gastric carcinoma in the elderly (clinical findings and results)].

On the basis of a series of 643 patients operated on for gastric cancer, the Authors seek to establish whether this disease presents clinical differences with advancing age of such a nature as to have a significant effect on therapeutic management. The series is divided into two groups, the first consisting of patients aged below 70 and the second of patients aged over 70. The following aspects were evaluated: sex, tumour site, oncological stage, type of surgery performed, operative mortality, postoperative survival, as assessed in overall terms and also differentiated in relation to curative or palliative surgery and oncological stage. Analysis of the data confirms that, apart from certain particular aspects, carcinoma of the stomach in the elderly benefits from the same sort of indications and techniques as those proposed for younger patients, with comparable postoperative survival rates, but with a higher operative mortality. To achieve better operative results, what is needed, in addition to correction of metabolic and functional abnormalities, is thorough assessment of risk factors. In patients with tumours at advanced stages, usually characterized by very poor postoperative results, the presence of major risk factors may raise serious doubts as to the actual advisability of the surgical indication itself.

Actuarial Analysis↗
PubMedDate not supplied

[Treatment of hemorrhagic syndrome caused by peritoneovenous shunt with a flow regulation device].

A case of severe coagulopathy after peritoneovenous shunting for intractable ascites and hepatorenal syndrome in a cirrhotic patient is reported. It was controlled and solved without removal of the shunt, using a vascular tourniquet which allowed a regulation of the ascitic flow. The method seems susceptible of improvement and could be routinely used in risk patients.

Ascites↗
PubMedDate not supplied

[Design criteria for a computerized clinical database].

The techniques of data management constitute a principal field in medical informatics, both for systems oriented to sole information retrieval, and basic-systems for more sophisticated applications. The operative utility of a data base depends on a careful planning based on foreseen requirements, and on the observance of some methodological rules. Such as, a precised preliminary study for the selection of clinical data to include in the data base, the choice of better tools and methodologies for the data collection and the right programming of software for the management of the archives. The knowledge of these problems allows, in many cases, the programming of computerized data base to use efficiently in the management of clinical information and in the planning of research. These problems, which do not depend on the hardware used, are commonly found in these applications. However, they have to be solved either for the use of large data base in hospital, which run on mainframe, or for the archives of the department, which can be built by every clinician on his own personal computer.

Humans↗
PubMedDate not supplied

Changes in nutritional and immunologic parameters after preparation for colonic surgery.

In 15 patients about to undergo colorectal resection for cancer (group I), body weight, lymphocytes, albumin, prealbumin, complement components C3 and C4 and total hemolytic complement activity (TC) were evaluated on admission to hospital and after preroperative preparation which involved dietary restrictions for 5-9 days (450 calories, 25 g protein daily). The same parameters were evaluated in 15 patients admitted for other major surgery not requiring colonic preparation (group II). Statistically significant reduction in prealbumin, C3, C4 and TC were found only in group I. The observations suggest a relationship between immunonutritional status and preparation for large-bowel surgery, reproducing a state of acute malnutrition.

Adult↗