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Biomedical subjects

M Braga

Publications and source records attributed to M Braga.

At least 91 records · Page 5Linked to original sources
PubMed1995

Benefits of early postoperative enteral feeding in cancer patients.

OBJECTIVE: To evaluate the effect of the early postoperative administration of an enriched enteral diet in cancer patients. DESIGN: Randomised controlled study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: 77 consecutive patients undergoing curative surgery for gastric or pancreatic cancer. INTERVENTIONS: Patients were randomised into 3 groups to receive: a standard enteral formula (n=24); the same formula enriched with arginine, RNA, and omega-3 fatty acids (n = 26), isonitrogen isocaloric total parenteral nutrition (n = 27). Enteral nutrition was started within 12 h following surgery. Infusion rate was progressively increased reaching the full regimen on postoperative day (POD) 4. On admission and on POD 1 and 8, the following measurements were performed: serum level of total iron-binding capacity, albumin, prealbumin, retinol-binding protein (RBP), and cholinesterase. Delayed hypersensitivity response (DHR), IgG, IgM, IgA, lymphocyte subsets. and monocyte phagocytosis ability were also evaluated. Bioelectrical impedance analysis was performed preoperatively and on POD 2, 7, and 11. The rate and severity of postoperative infections and the length of hospital stay were evaluated. RESULTS: In all patients, a significant drop of nutritional and immunologic parameters was observed on POD 1. A significant increase of prealbumin (p<0.02), RBP (p<0.005), monocyte phagocytosis ability (p<0.001), and DHR (p<0.005) was found on POD 8 only in the group fed with the enriched diet. A significant reduction of severity of postoperative infections and length of postoperative stay was found in the group with the enriched diet compared to the other groups. CONCLUSIONS: These data are suggestive of an improvement of the nutritional and immunologic status and clinical outcome in cancer patients who receive an enriched enteral diet in the early postoperative course.

Aged↗
PubMed1995

Impact of a programme of autologous blood donation on the incidence of infection in patients with colorectal cancer.

OBJECTIVE: To assess the effects of both autologous and homologous blood transfusion on the incidence of infective complications after elective operations for colorectal cancer. DESIGN: Prospective open study. SETTING: University hospital, Italy. INTERVENTIONS: Recording of variables known to influence the development of infection. MAIN OUTCOME MEASURES: Infective morbidity and mortality. RESULTS: Fifty-three patients (33%) deposited their own blood. Eighty-six of the 161 (53%) patients were transfused, 36 were given autologous blood, 48 homologous blood and 2 both autologous and homologous blood. These two were excluded from the analysis. Infective complications developed in 28 patients (17%), of which 7/75 (9%) were in patients who had not been transfused, 5/56 (14%) in patients given autologous transfusion, and 16/48 (33%) in patients given homologous transfusions (p < 0.001). Multivariate analysis identified homologous blood transfusion as the only variable significantly associated with the development of postoperative infective complications. No patient died. CONCLUSION: Transfusion of autologous blood was associated with significantly fewer postoperative infective complications than transfusion of homologous blood or no blood transfusion.

Adult↗
PubMed1995

[The analysis of the spatial aggregation of health events using risk surface density estimation methods].

Methods for the analysis of the spatial aggregation of health events has received growing attention under the pressure of public opinion concern and as tools for the identification of potential risk sources, for monitoring relevant geographical areas and, finally, for public health decisions. The development of statistical methods for the detection and localization of spatial clusters has mainly concerned individual data. This paper is aimed at describing one of the methods proposed for the identification of clusters in the case of information at individual level and at presenting its extension to grouped data. This method, the surface density estimation method using the Kernel approach, offers remarkable advantages in terms of simplicity of implementation and flexibility, this latter being an extremely important characteristic in the case of exploratory analyses. For exemplification purposes, the density estimation method has been applied to individual data concerning the spatial distribution of cerebral tumors in Campi Bisenzio (FI) and to the distribution of gastric cancer mortality in the municipalities around Arezzo and Pesaro.

Brain Neoplasms↗
PubMed1995

[A new approach for the automatic detection of health event clusters].

The Italian Morality Atlas at municipality level, sponsored by the Health Ministry and realized by the Emilia-Romagna region in collaboration with the Institute of Medical Statistics of Milano, is aimed at: 1) supporting and stimulating the local production of mortality maps and the use of geographical data; 2) providing a working and research tool to local health planners; 3) setting a routine procedure for the detection of spatial clusters. This procedure is organized in several steps: the definition of the spatial domain and of the spatial distance metrics; the choice of the effect indicator and the standard population; the estimate of the density risk surface via kernel methods; the identification of "local maxima"; the analysis of local maxima for cluster detection; the description of the identified clusters. The paper investigates the meaning and the characteristics of spatial clusters, describes the procedure for their identification and discusses the opportunity to use an automated approach for map reading.

Cervical Atlas↗
PubMed1995

Soluble interleukin-2 receptor (sIL-2R) levels in renal transplantation: comparison between clinical and laboratory analysis.

Soluble interleukin-2 receptor levels (sIL-2R) were retrospectively evaluated in 43 consecutive kidney transplant recipients (22 males, 21 females), from day 0 up to 90 days after transplantation. 11 pts were on CsA only, 13 on CsA + MP and 19 on CsA + MP + Aza. All graft-worsening episodes were then retrospectively analyzed, either according to clinical criteria only, or taking into account sIL-2R levels. On clinical grounds, 50 rejections were observed: "a posteriori" 5 turned out to be either infections or non-immunological worsenings of graft function (prevalence of misdiagnosis in the rejection set: 5/50, 10%). Of the 8 infections, 2 were actually treated as rejections (margin of error: 2/8, 25%). CsA toxicity was correctly diagnosed in 2/4 episodes. The analysis based on sIL-2R levels increase confirmed the clinical diagnosis in 52/79 cases (66%). The prevalence of misdiagnosis was: 21.2% in rejection, 2/3 in CsA toxicity, while infections were overestimated in 60% of cases. Isolated sIL-2R level increase was not associated with rejection in 87.5% of cases, while an associated increase of IL-2R and plasma creatinine had a 5% chance of being wrong. SIL-2R levels increased before any rise in plasma creatinine in late rejections (28 +/- 21 days after transplantation), while they increased after the rise of plasma creatinine in early rejections (10 +/- 5 days) (p = 0.014). In the rejection set, sIL-2R had a sensitivity of 83.4%, a specificity of 80%, a positive predictive value of 50.2% and a negative predictive value of 95.2%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Nutritional support in acute pancreatitis].

Severe acute pancreatitis 3 or more Ranson's prognostic signs is characterized by a generalized hypermetabolic response and nutritional depletion leading to malnutrition and septic complications. Nutritional support has come to be a significant component of the treatment of acute pancreatitis. However the route of nutrient administration and composition of substrates administered remain controversial. Available data suggest that intravenous infusion of amino acids, glucose and fat emulsions alone or in combination does not stimulate exocrine pancreatic secretion. Similarly, enteral feeds should have low fat composition and be delivered distal to the ligament of Treitz. This review outlines the current body of specific literature and provides preliminary guidelines for the nutritional support of patients with acute pancreatitis.

Acute Disease↗
PubMed1995

[The intestine: a central organ in the pathogenesis of septic complications in acute pancreatitis].

Despite the array of new diagnostic and therapeutic tools, acute pancreatitis remains a critical condition with a high rate of septic morbidity and mortality. To date the main cause of death is still the occurrence of septic complications. In 80% the cases, the microorganisms responsible for infection are of enteric origin and in 30% of the patients with septic shock, no evident focus of infection is recognized. Bacterial translocation is increasingly accepted as the main cause of infection, sepsis and multiple organ failure in these critically ill patients. The mechanisms facilitating the loss of gut barrier function are overgrowth of enteric bacteria and damage to the intestinal mucosa. Pancreatitis-induced immunosuppression may allow the systemic spread of translocated organisms and subsequent severe septic sequelae.

Acute Disease↗
PubMed1994

Estimation of pooled reference values for cadmium in blood using meta-analysis and TRACY criteria.

Reference values for blood-cadmium levels (B-Cd) are available for only a limited number of geographical areas and for particular population strata (sex, age, smoking habits). This paper, in agreement with the TRACY guidelines, describes and discusses the criteria used to rank published papers on reference values for cadmium retrieved by Medline and Toxline between 1976 and 1991. The TRACY criteria deal with the grading of published papers in terms of their suitability for calculating provisional reference values. Only four out of 18 papers were considered suitable for the TRACY project. The four articles were finally used via meta-analysis to provide provisional reference values for smokers and non-smokers. The comparison of results obtained using published statistics and individual data is used to discuss the appropriateness of meta-analysis in the case of cadmium. Due to the availability of large enough studies and to the clear differences across countries, the suitability of a compound upper reference limit to B-Cd levels seems limited.

Adult↗
PubMed1994

Impact of thymopentin on the incidence and severity of postoperative infection: a randomized controlled trial.

The effectiveness of perioperative administration of thymopentin in preventing postoperative infection was evaluated in 206 patients with cancer (54 gastric, 152 colorectal) who underwent elective major surgery. Comparable subsets of patients were obtained with respect to age (proportion over 65 years) and nutritional status (patients with serum albumin level less than 30 milligrams or weight loss of 10 per cent or more of usual body-weight were considered to be malnourished). Patients were then randomly assigned to a control group or to a group receiving thymopentin. All patients received perioperative short-term antibiotic prophylaxis and postoperative parenteral nutrition. Levels of CD3-, CD4- and CD8-positive T cell subsets were evaluated before and after surgery in 20 (ten elderly) patients from each group. The severity of postoperative infection was evaluated using a sepsis score. In elderly patients thymopentin prevented the postoperative drop in CD3- and CD4-positive T cell subpopulations that was observed in controls (P < 0.05d). The postoperative infection rate was 17.5 per cent in the group given thymopentin and 24.3 per cent in controls (P not significant). The mean (s.d.) sepsis score was 6.7 (3.1) in the group receiving thymopentin and 9.4 (5.8) in controls (P not significant). Considering only elderly patients, the mean (s.d.) sepsis score was significantly lower in those treated with thymopentin than in control patients (6.9(2.1) versus 11.3(4.7)). In conclusion, administration of thymopentin did not significantly reduce the postoperative infection rate. However, it prevented the drop in number of CD3- and CD4-positive T cells after operation and reduced the severity of postoperative infection in elderly patients.

Adult↗
PubMed1994

Prognostic factors for hepatocellular carcinoma in genetic hemochromatosis.

To identify factors that might be useful as prognostic indexes for the risk of hepatocellular carcinoma in Italian patients with genetic hemochromatosis, 152 homozygotes were studied prospectively for 1 to 229 mo. Factors that were considered in estimating the risk of developing hepatocellular carcinoma were age, sex, cirrhosis (Child class), HBsAg, antibodies to HBsAg, antibodies to HBcAg, hepatitis C antibodies, alcohol abuse and the amount of iron removed during therapeutic phlebotomy to produce iron depletion. At diagnosis, cirrhosis was present in 97 patients and absent in 55. During follow-up, hepatocellular carcinoma developed in 28 of the 97 patients with cirrhosis but in none of those without. Among patients with cirrhosis, the cumulative probability of being free of hepatocellular carcinoma at 10 yr was 70%. For patients with and without HBsAg the probabilities of being free of liver cancer at 10 yr were, respectively, 54% and 75%; for those with and without history of alcoholism, 58% and 78%; and for those younger and older than 55 yr, 90% and 54%. In patients with cirrhosis, multivariate analysis using proportional-hazards (Cox) regression found that the only factors contributing significantly to the estimation of a prognostic index were age, presence of HBsAg and alcohol abuse. Age over 55 yr increased the relative risk of hepatocellular carcinoma 13.3-fold (p < 0.001), the presence of HBsAg increased it 4.9-fold (p < 0.02) and alcohol abuse increased it 2.3-fold (p < 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

A reconsideration of the relationship between cerebral structural abnormalities and family history of schizophrenia.

In a study of 229 schizophrenic patients for whom reliable family history information was available, ventricular size and incidence of ventricular enlargement were found to be greater in male cases without a family history of schizophrenia. A significant sex by family history interaction on cerebral ventricular dimension was detected. The age-corrected morbid risk for schizophrenia was lower among first degree relatives of male probands with ventricular enlargement vs. those with normal ventricles, but similar in relatives of females with and without ventricular enlargement. On the other hand, no association was found between family history and degree of cortical atrophy. A meta-analysis of published studies on the issue revealed 20% larger ventricles in patients without any known genetic predisposition for schizophrenia.

Adolescent↗
PubMed1994

Impact of enteral nutrition on intestinal bacterial translocation and mortality in burned mice.

The aim of these experiments was to study the effect of early enteral nutrition with either standard or enriched (arginine, n-3 fatty acids, RNA) enteral formulas on translocation of bacteria from the gut and acute mortality rate following thermal injury. In the first experiment 60 Balb c mice were gavaged with 10(10)Escherichia coli and received a 20% burn injury. In 40 mice enteral nutrition (20 standard, 20 enriched) was started immediately after injury and stopped 36 h later. In the control group (n = 20) aliquotes of Ringer's solution was administered intragastrically. Mortality rate was observed for 10 days post-injury. In the second experiment 60 Balb c mice were gavaged with 10(10)E. coli labelled with biotin(111) Indium and then burned. In 40 mice enteral nutrition (20 standard, 20 enriched) was started immediately after burn. The control group (n = 20) received aliquotes of Ringer's solution. 4 h after injury all animals were sacrificed and liver, lungs, kidneys, spleen and systemic blood were harvested, and radionuclide counts were measured. No animal died after day 3 post-burn. The mortality rate was significantly lower at day 1 in the groups infused with both enteral solutions (15%) compared to controls (30%; p = 0.05). At day 3 the animals fed with the enriched diets showed a lower mortality (5%) versus the standard and control groups (10%). Bacterial translocation to the liver and lungs was significantly higher in Ringer's group than in both enterally fed groups. Early post-burn enteral nutrition reduces both translocation and acute mortality. Supplementation of the diets with specific nutrients appears to exert additional advantages on outcome.

Journal Article↗
PubMed1994

Results of a multicenter study assessing the status of standardization of a recombinant thromboplastin for the control of oral anticoagulant therapy.

An international collaborative study involving 20 laboratories was undertaken to evaluate the status of standardization of a commercial recombinant thromboplastin. The results show that the reagent fulfills the WHO requirements for thromboplastin calibration against two International Reference Preparations (IRP) from different species, because there was a linear relationship of log-transformed prothrombin times as measured by the recombinant reagent and the two IRPs in normal individuals and patients stabilized on oral anticoagulants. The regression lines drawn through the patient data points passed through the normal data points in the majority of instances. The average ISI values for three different batches were close to unity. On the average, the ISI value calculated against BCT/253 (human, plain) was slightly smaller than that against RBT/79 (rabbit, plain). The between laboratory precision of calibration (CV = 5-6%) did not change whether BCT/253 or RBT/79 was used, whereas it was substantially improved when the calibrations of batches 2 and 3 were performed against batch 1, arbitrarily taken as standard (CV < or = 1.7%). Statistical analysis to test for differences between slopes revealed no significant between-batch differences in 16 of 20 laboratories. However slight differences for the third batch (2.8% less than the average ISI value of batches 1 and 2) leave room for further improvement in the standardization of the reagent.

Animals↗
PubMed1994

Reference values for respiratory rate in the first 3 years of life.

BACKGROUND: Raised respiratory rate is a useful sign to diagnose lower respiratory infections in childhood. However, the normal range for respiratory rate has not been defined in a proper, large sample. OBJECTIVE: To assess the respiratory rate in a large number of infants and young children in order to construct percentile curves by age; to determine the repeatability to the assessment using a stethoscope and compare it with observation. METHODS: Respiratory rate was recorded for 1 minute with a stethoscope in 618 infants and children, aged 15 days to 3 years old, without respiratory infections or any other severe disease when awake and calm and when asleep. In 50 subjects we compared respiratory rate taken 30 to 60 minutes apart to assess repeatability, and in 50 others we compared simultaneous counts obtained by stethoscope versus observation. RESULTS: Repeatability was good as the standard deviation of differences was 2.5 breaths/minute in awake and 1.7 breaths/minute in asleep children. Respiratory rate obtained with a stethoscope was systematically higher than that obtained by observation (mean difference 2.6 breaths/minute in awake and 1.8 breaths/minute in asleep children; P = .015 and P < .001, respectively). A decrease in respiratory rate with age was seen for both states, and it was faster in the first few months of life when also a greater dispersion of values was observed. A second degree polynomial curve accurately fitted the data. Reference percentile values were developed from these data. CONCLUSIONS: The repeatability of respiratory rate measured with a stethoscope was good. Percentile curves would be particularly helpful in the first months of life when the decline in respiratory rate is very rapid and prevents to use cut off values for defining "normality."

Aging↗
PubMed1994

[Immunologic aspects of artificial nutrition].

Artificial nutrition (AN) has become an essential part of traumatised and surgical patient care. The main indications for AN are severe undernutrition and hypermetabolism, which are important causes of immunosuppression. Total parenteral nutrition has proved to be as beneficial in the perioperative period only in malnourished subjects. In contrast, overfeeding may cause detrimental sequelae with an increase in postoperative complications. Experimental and clinical trials have clearly shown that the administration of nutrients via the enteral route versus the parenteral one has several advantages, including improved local and systemic immune response and gut barrier function with the subsequent reduction of septic morbidity. Preliminary data in traumatised and surgical patients have shown further immunological and clinical advantages when the composition of the enteral solutions has been enriched with specific nutrients capable of enhancing the host defence mechanisms. The most important are arginine, n-3 fatty acids, RNA, and glutamine.

Humans↗
PubMed1993

"Within patient"-dependent outcomes in graft occlusion after coronary artery bypass. SINBA Group.

In clinical trials aimed at assessing the efficacy of drugs after coronary artery grafting, statistical analysis is usually carried out on a per-patient basis and on a per-graft basis. Owing to the independence of responses among patients, the former outcome is analyzed by assuming a binomial model. However, this model cannot be directly adopted in analyzing the latter outcome because multiple vein grafts in the same patient do not act independently. It has been suggested that patients be considered as clusters of distal anastomoses, subsequently comparing the frequencies of occlusion under different treatments after adjusting the variance of each frequency for the size of the cluster. Alternatively, one can measure the intraclass (intrapatient) correlation coefficient and adopt distribution functions that include this quantity as one of the parameters. This approach has been adopted by many authors although the studies differed in the statistical model used to represent this kind of data. Two probability functions, Altham's and beta-binomial, have found wide application in different biomedical fields. Both are able to model the extrabinomial variability since their tails tend to zero more slowly than those of the binomial distribution. An alternative to adopting a specific probabilistic model consists of specifying a mixed model or a Markov-like susceptibility model. These models follow the same rationale since they assume the existence of two processes, one that causes an individual to become susceptible to occlusion, the other that determines the subsequent probability of occlusion in the individual. After presenting these models in a unified framework, this paper compares the estimates obtained by fitting the models to data gathered at coronary angiography 1 year after surgery by the SINBA group on a total of 847 saphenous vein anastomoses in 349 patients. Finally, the issue concerning the contribution of each patient to the effective sample size is discussed.

Coronary Angiography↗
PubMed1993

Hypertension after renal transplantation.

In 212 cyclosporine-treated renal transplant recipients with stable graft function at 1 year and with potential follow-up of 5 years the prevalence of arterial hypertension was 81.6% at 1 year and 81.2% at 5 years. The logistic regression analysis showed that the presence of hypertension before transplantation (P = 0.0001; odds ratio 3.5), a plasma creatinine level higher than 2 mg/dL at 1 year (P = 0.0001; odds ratio 3.8), and a maintenance therapy with corticosteroids (P = 0.008; odds ratio 3.3) were positively associated with hypertension at 1 year after transplantation. The mean number of graft failures between 1 and 5 years was significantly higher and the mean reciprocal of plasma creatinine was significantly worse at 1 and 5 years in patients with noncontrolled hypertension than in normotensive patients or in patients with hypertension well controlled by drugs. We also investigated the potential protective role of nifedipine. The episodes of acute tubular necrosis (four versus three), of acute rejections (28 versus 29), the mean arterial pressure at 1 year (105 +/- 9 versus 104 +/- 9 mm Hg) and 5 years (105 +/- 10 versus 108 +/- 12 mm Hg), and the mean plasma creatinine level at 1 year (1.4 +/- 0.4 versus 1.6 +/- 0.4 mg/dL) and 5 years (1.8 +/- 1 versus 1.9 +/- 1 mg/dL) were similar in 52 patients who were given nifedipine for at least 4 years and 58 hypertensive patients who never took calcium channel blockers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗