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Biomedical subjects

M Braga

Publications and source records attributed to M Braga.

At least 127 records · Page 7Linked to original sources
PubMed1990

[Malnutrition after total gastrectomy].

We studied food intake and nutritional status of 28 patients who had undergone total gastrectomy for gastric cancer. At discharge, patients were instructed to keep a high protein, high calorie diet and to record food intake on a specific form, twice weekly. Nutritional follow-up, consisting in a computerized determination of dietary intake and nutritional assessment was performed monthly during the first postoperative year. The average calorie intake was 1,431.8 Kcal/day one month after operation and 2,225.4 Kcal/day one year after surgery (p less than 0.001). In particular, only one patient exceeded 2,000 Kcal/day one month after total gastrectomy, while 21 patients exceed 2,00 Kcal/day one year after operation. The evaluation of nutritional parameters in the postoperative course showed that a significant increase in body weight, serum albumin and total iron binding capacity was observed only in patients who exceed 2,000 Kcal/day one year after operation. These results indicate that malnutrition is not an inevitable consequence of total gastrectomy; in fact, a close relationship between calorie intake and the variations of nutritional parameters was observed.

Adult↗
PubMed1990

[Impact of a surveillance and prevention program on the incidence of wound infections in general surgery. A prospective study].

A prospective study on wound infections incidence was performed using a computer archive program. Data of 7000 patients submitted to surgical procedures from 1980 to 1988 were evaluated regarding a surveillance and a prevention program that was performed at 1984 (short term prophylaxis in contaminated and any clean-contaminated procedures; skin washing before the operation with a soapy solution of povidone iodine; regular report of all data about wound infection incidence to staff). Results were evaluated in four classes and regarding nutritional status. The reduction of wound infection incidence was statistically significant (1.8% vs 5.4%; chi square 63.70, p less than 0.001) and an important reduction was recorded in the malnourished patients (3.0% vs 15.4%; chi square 36.91, p less than 0.001).

Humans↗
PubMed1990

Postoperative management of patients with total exocrine pancreatic insufficiency.

The occurrence of maldigestion and malnutrition was studied in 14 patients who had undergone pancreaticoduodenectomy and occlusion of the Wirsung duct with Neoprene. Before discharge patients were put on a 70 g/day dietary fat intake. Mean faecal fat excretion was 32.9 g/day without enzyme replacement and fell to 14.2 g/day with pancrelipase supplementation. At discharge all patients were underweight (88 per cent of the usual mean body-weight) and nine patients showed alteration in laboratory nutritional parameters. At the time of discharge a low-fat diet (50 g/day) was prescribed. Six months after surgery, mean faecal fat excretion decreased further to 8.3 g/day (P less than 0.01) and all patients but one gained weight, reaching 93 per cent of the usual mean body-weight with normalized nutritional parameters. Our data show that the combination of enzyme replacement therapy and low-fat diet allows good correction of steatorrhoea and a significant improvement in nutritional status.

Adult↗
PubMed1990

Haemodynamic effect of triglycyl-lysine-vasopressin (glypressin) on intravascular oesophageal variceal pressure in patients with cirrhosis. A randomized placebo controlled trial.

A double-blind random administration of 2 mg glypressin intravenously (i.v.) or placebo was given to 20 volunteer patients suffering from liver cirrhosis with portal hypertension and oesophageal varices. Experimental protocol required two basal intravascular oesophageal variceal pressure (IOVP) measurements, before and after bolus i.v. drug injection. The second measurement was taken as reference to determine whether the treatment was effective. Other measurements were taken 1, 3, 5 and 10 min after drug administration. The fall in IOVP at 3, 5 and 10 min in the patients who had been administered glypressin proved statistically significant (p less than 0.01) with mean percentage variations of -22.3%, -24.4% and -27.9%, respectively. In conclusion, the administration of glypressin in portal hypertensive patients brought about a marked reduction in transmural oesophageal variceal pressure in over 70% of the cases. This decrease may prove to be of clinical importance both as a first line therapy and as a possible aid to emergency sclerotherapy in the presence of active variceal bleeding.

Adult↗
PubMed1990

[Several risk indicators in industrial accidents].

Since the 1986, the National Institute for Occupational Accident Insurance (INAIL) provides each single Region with the occupational accident data on magnetic support. This strengthens the need to critically evaluate the most commonly used risk indicators. In this paper we discuss advantages and limits of the usual frequency and severity measures; the formulae for the standard errors are also given. A method proposed by I. Bross (1958), the RIDIT Analysis, is considered and exemplified. The appealing properties of this method ask for a more extensive application in this field.

Accidents, Occupational↗
PubMed1989

Prognostic ability of nutritional assessment methods in surgical cancer patients.

To identify patients at high-risk for post-operative infections, several methods have been proposed, including prognostic nutritional index (PNI), instant nutritional assessment (INA) and nutritional assessment (NA). Weight loss (WL) has also been related to post-operative morbidity. We have evaluated the prognostic ability of PNI, INA, NA and WL in a prospective study carried out in 94 patients affected by gastro-intestinal malignancy, who underwent major surgery. Post-operative infections occurred in 26 (27.7%) patients. PNI, INA and NA identified classes of patients with a progressive risk of septic complications. To determine the prognostic ability of PNI, INA, NA and WL, sensitivity, specificity, Youden index and predictive values were evaluated. All methods had a Youden index greater than one, with a positive predictive value ranging from 0.33 to 0.36. Since all the methods studied showed a similar predictive ability, it seems reasonable to identify the high-risk surgical patient by using weight loss in association with those nutritional parameters derived from routine hospital laboratory tests.

Journal Article↗
PubMed1989

Passive limitation of adduction after Cüppers's 'Fadenoperation' on medial recti.

In 40 eyes of 20 esotropic subjects in which a 'Fadenoperation' was performed on the medial recti we measured the resistance to ocular rotation in adduction before and after the operation. The difference between the two sets of force measurements demonstrates that the Fadenoperation on medial recti produces a mechanical restriction to adduction which can explain the effect of the surgical procedure on the strabismic deviation.

Child↗
PubMed1989

[Effect of histamine on the positive reactions produced during skin tests].

The effect of histamine control on the reaction produced by adjacent allergens or diluent control during skin test was evaluated in 742 patients sensitized to one or more inhalant allergens. In 4 cases (0.7%) both the diluent control and all the tested allergens were positive thus indicating an altered cutaneous reactivity. The allergens placed near the histamine control were positive in 183 cases (24.7%). Among these 144 (19.4%) were strong positive results according to the history. In 39 cases (5.2%) the positive result didn't correlate with the history. Of note in 35 cases (4.7%) the reaction was classified as weak positive (+) according to Berg and Johansson (1974). Although our findings confirm only partially those from Terho and Coworkers, we agree with the Authors on the opportunity of positioning the histamine control at a suitable distance from other allergens during skin test.

Allergens↗
PubMed1989

Pancreatic enzyme replacement therapy in post-pancreatectomy patients.

The occurrence of malnutrition and maldigestion was studied in nine patients who underwent pancreatoduodenectomy and sclerosis of the residual pancreatic stump with neoprene. The operation causes a complete loss of exocrine pancreatic function, but spares islet cell function. Upon discharge from the hospital, patients received pancreatin powder as a dietary enzyme supplement (18,000 lipase U/meal). Patients were again hospitalized 2 y after surgery for evaluation of nutritional status and digestive function (hospital checkup). Nutritional status was evaluated by measuring serum albumin, total iron binding capacity, and total lymphocytes. Digestive function was assessed by the D-xylose tolerance test and determination of fecal fat excretion. Patients were then discharged with pancrelipase enteric-coated microspheres (ECM) as a dietary enzyme supplement (16,050 lipase U/meal). Malnutrition, defined as the occurrence of at least two abnormal nutritional parameters, was observed in three patients at the time of the hospital checkup. Upon reevaluation of nutritional status after 6 mo on pancrelipase ECM, all patients were well nourished. The mean body weight, which had been 52.8 Kg immediately after surgery, increased to 54.9 Kg at the time of the hospital checkup (p less than 0.01) and to 58.0 Kg after six months of pancrelipase ECM therapy (p less than 0.05). At the hospital checkup, the D-xylose test was normal in all patients and steatorrhea had decreased from a mean of 32.8 g/d without enzyme supplementation to 16.7 g/d with pancrelipase therapy (16,050 lipase U/meal). The complete loss of exocrine pancreatic function following surgery was well tolerated. In fact, when patients were on pancrelipase therapy, much of the original body weight was recovered and the biochemical indices of malnutrition were normalized.

Adult↗
PubMed1988

Intralaboratory reproducibility of interpretation of Pap smears: results of an experiment.

One hundred and twenty Pap-smears were examined by 3 cytotechnologists on two occasions in the Legnano Hospital Cytologic Center. A 10-category classification system was used. Chance-adjusted overall and category-specific agreement was estimated (Cohen's unweighted kappa-statistics) within and between cytotechnologists. Mean K for the Center, weighted for precision, was 0.432, S.E. 0.029 (between cytotechnologists). The most reproducible categories (between cytotechnologists) were "9: malignant cells" (K = 0.683) and "1: normal" (K = 0.533); the least reproducible categories were "4: endocervical metaplastic cells" (K = 0.024) and "8: severe squamous dysplasia CIN III" (K = 0.227).

Female↗
PubMed1988

An uncommon cause of massive intraperitoneal bleeding: leiomyoblastoma of the stomach.

A large exogastric leiomyoblastoma in a 48-year-old male revealed by asymptomatic upper abdominal mass is reported. Abdominal ultrasound, computerized tomography scan and magnetic resonance showed a 20 cm cystic lesion apart from liver and pancreas of undetermined origin. During hospitalization, massive intraperitoneal bleeding due to rupture of the mass was observed. An emergency laparotomy was carried out, and excision of a large, ruptured, cystic mass involving the greater gastric curvature was performed. Microscopy revealed a gastric leiomyoblastoma. Even if infrequent, massive intraperitoneal bleeding is a very serious complication of gastric leiomyoblastoma. Considering the difficulty of an accurate preoperative diagnosis and the risk of intraperitoneal rupture, the authors suggest that similar abdominal masses should be managed by quick diagnostic investigations and early surgical procedures.

Hemorrhage↗
PubMed1988

Correction of malnutrition and maldigestion with enzyme supplementation in patients with surgical suppression of exocrine pancreatic function.

We studied the occurrence and extent of malnutrition and maldigestion in 13 patients who underwent pancreatoduodenectomy (PD) and injection of Neoprene (polychloroprene) (NI) into the duct of Wirsung, which results in sclerosis of hte acinar pancreatic tissue, but spares the endocrine function. At discharge, patients under took an enzyme supplementation regimen with pancreatin (18, 00 United States Pharmacopoeia units of lipase per meal). Patients were rehospitalized 24.9 months after PD plus NI to undergo nutritional and metabolic evaluation (hospital control). Nutritional status was evaluated by measuring the serum albumin level, total iron binding capacity and total lymphocyte count. Digestive function was assessed by the D-xylose tolerance test and determination of fecal fat excretion. Patients were then discharged with pancrelipase, enteric-coated microspheres (ECM) supplementation (16,050 United States Pharmacopoeia units of lipase per meal). Malnutrition, defined as the occurrence of at least two abnormal nutritional parameters, was observed in six patients at hospital control. After six months on pancrelipase ECM, the nutritional status was re-evaluated in nine patients (three previously malnourished) who were all well nourished. The mean body weight was 84.7 per cent of usual body weight at discharge after PD plus NI and raised to 88.0 per cent at the hospital control (p less than 0.01) and to 93.7 per cent )p less than 0.05) after six months on pancrelipase ECM. At hospital control, results from the D-xylose test were normal in all patients, and steatorrhea dropped from 33.6 grams per day without enzyme supplementation to 15.3 grams per day with pancrelipase ECM (16,050 United States Pharmacopoeia units of lipase per meal). Steatorrhea was incompletely but satisfactorily corrected by pancrelipase ECM. On supplementation therapy with pancrelipase ECM, patients recover a good deal of the body weight and normalize the biochemical indices of malnutrition.

Adult↗
PubMed1988

Effectiveness of antibiotic prophylaxis according to the nutritional status in patients undergoing contaminated procedures.

The attempt to restrict as much as possible the use of the antibiotics in surgery is related with the recent introduction of short term antibiotic prophylaxis. In this study the possibility to select among patients undergoing contaminated procedures those who can benefit more from short term antibiotic prophylaxis was considered. With this aim the nutritional status of 302 patients according to three parameters: serum albumin, total iron binding capacity and weight loss, was assessed. Results obtained from short term antibiotic prophylaxis with clindamycin and gentamicin in 149 patients (53.6% malnourished) were compared with those obtained in 153 patients (49.6% malnourished) who were not treated peroperatively. Wound infection rate in patients who received antibiotic prophylaxis was 6% versus 15% in the group which did not receive antibiotics peroperatively (p less than 0.025). A significant reduction was observed in malnourished patients while in the well-nourished the decrease was not significant. Malnourished patients seem to gain a specific benefit from antibiotic prophylaxis.

Adolescent↗
PubMed1988

Food intake and nutritional status after total gastrectomy: results of a nutritional follow-up.

We studied dietary intake and nutritional status of 23 patients for 6 months after total gastrectomy with Roux-en-Y reconstruction. At discharge, patients were instructed to keep to recommended dietary allowances (RDA) and to record food intake on a specific form twice weekly. Nutritional follow-up was performed monthly and consisted of a computerized determination of food intake and of a nutritional assessment. The average daily energy intake was 6.10 MJ (1457.9 kcal) in the first postoperative month and 8.87 MJ (2118.4 kcal) in the sixth (P less than 0.0005). In the first monthly follow-up no patient reached RDA. By the sixth month mean daily calorie intake was greater than or equal to RDA in 14 patients (group A), while 9 patients (group B) did not reach RDA. A significant increase in body weight, serum albumin, total iron binding capacity and arm muscular circumference was observed in group A, while a significant decrease in body weight and arm muscular circumference was noted in group B. Moreover, of the seven patients who showed weight loss at 6 months only one was group A. These data indicate that malnutrition is not an inevitable consequence of total gastrectomy and can be prevented by an adequate calorie intake. A close relationship between dietary intake and postoperative nutritional parameters was observed. In gastrectomized patients a strict nutritional follow-up is very important to obtain an adequate dietary intake.

Adult↗
PubMed1987

[Evaluation of the delayed hypersensitivity response by the Multitest-IMC. Multicenter study for the definition of reference values in a sample population].

The latest investigations in the field of clinical immunology have proposed ways of assessing immunological efficiency that have also been used to identify patients most susceptible to infectious complications. The assessment of delayed hypersensitivity response (DHR) using anamnestic antigens is currently the most common method. The results of a polycentric study are presented. The study was conducted on a group of healthy subjects from various Italian regions divided into three age classes. Positive responses to the MT were noted in 96.4% of the population studied. The incidence of energy was statistically higher among females than males, while the mean response to the MT expressed in millimetres was statistically higher in males. Though 7 antigens were administered, the responsive population reacted on average to 3. The highest incidence of positive responses was to Candida, with Trichophyton responsible for the fewest.

Adolescent↗